Introduction Endoscopic papillectomy is an alternative to radical surgery (10% mortality risk) in the management of ampullary adenomas. Very few centres in the UK have the expertise or experience of performing this procedure and there is certainly no published literature from the UK. We aim to report outcomes after endoscopic papillectomy in a single tertiary endoscopy unit in the UK.

Method The prospectively collected data of all patients who underwent endoscopic papillectomy between 2005 and 2015 in Queen Alexandra Hospital, Portsmouth were reviewed. All procedures were carried out by PB (papillectomy) and PG (ERCP) using a standard duodenoscope. The pancreatic and biliary ducts were cannulated. A dilute methylene blue dye was injected into the pancreatic duct prior to papillectomy. Submucosal injection was performed in all cases prior to snare resection of the ampullary neoplasia. 5 Fr pigtail pancreatic stent insertion was attempted in all cases after resection of the neoplasia.

Results A total of thirty-five patients were referred for papillectomy but only twenty-two patients (13 female, median age 72 years) underwent a total of 24 papillectomies. En-bloc resection was achieved in 17 patients (77%) with lesion sizes ranging from 8–25 mm (Median 16 mm). Pancreatic stent placement was successful in 82% of all papillectomies. Three patients experienced complications (12.5%); 2 bleeding and 1 acute pancreatitis. There was no procedure related deaths and no one required emergency surgery. There were no local recurrences in 77% of patients. Two patients required 2 attempts to achieve complete clearance of their adenomas. Histology of the resected lesions revealed low grade dysplasia (54.6%), high grade dysplasia (27.2%), cancer (9%), gangliocytic paraganglioma (4.6%), and neuroendocrine tumour (4.6%). Of the two patients who were found to have invasive cancer, the first patient went on to have a pancreaticoduodenectomy and subsequently died of post-operative complications and the second patient was palliated. The total curative resection rate was 86%.

Conclusion This is the largest reported UK series of endoscopic papillectomy. Our data demonstrates that this method is a feasible, safe and efficacious means of treating ampullary neoplasia in expert hands. It obviates the need for pancreaticoduodenectomy with its inherent morbidity and mortality. Complications can be serious and expertise is required to deal with them.

Disclosure of interest None Declared.

References

1. Suzuki K, Kantou U, Murakami Y. Two cases with ampullary cancer who underwent endoscopic excision. Prog Dig Endosc. 1983;23:236–239

2. De Palma GD. Endoscopic papillectomy: indications, techniques, and results. World J Gastroenterol. 2014;20(6):1537–1543