Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms

Abstract

Background The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear. Objective To assess the safety, feasibility and outcomes of these patients treated by thermal ablation. Methods Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6‐month minimum follow‐up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow‐up. Results Of 86 patients presenting with an ampullary tumor, 73 (58 ± 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8–80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively. Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20‐month median follow‐up. Most of these patients had malignant forms ( n = 8, 66.7%), with a higher adenocarcinoma rate (33.3% versus 3.3%, p = 0.001) compared to extraductal tumors. Overall, there was a 20.5% complication rate with no significant differences between both groups ( p = 0.676). Conclusions Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with ≤20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery.