Researchers, among them Thierry Ponchon, MD, professor of medicine at the Centre Hospitalier Universitaire de Lyon, completed a large prospective multicenter study of endoscopic ampullectomy in 93 consecutive patients from September 2003 to January 2006. Patients were included in the study if they had positive biopsies (at least adenoma), and no previous ampullectomy or laser treatment. Endoscopic ampullectomies were conducted by 11 experienced endoscopists using a side-viewing endoscope under sedation. If pathological examination of the resected area was different from the initial biopsies, a second look was performed by an experienced pathologist.
To determine the effectiveness of the procedure, patients were followed-up between four and eight weeks, undergoing a complementary resection if necessary. Patients were then followed up with at six, 12, 18, 24 and 36 months with systematic biopsies. The procedure was considered curative if the resection was complete, no submucosal carcinoma was observed, control of the cancer was normal at six months and no relapses were observed during follow up period.
Researchers observed an 80 percent rate of success in patients, and a 95 percent success in analyzable patients. Sixty-eight patients with complete resection had a follow-up: 57 had normal 36-month control and were considered cured; three had incomplete follow-up, asymptomatic but without control; five died of other diseases; and three had a tumor recurrence at 12 and 24 months.
"Our study demonstrates that endoscopic ampullectomy is an effective alternative to surgery for the treatment of ampullary adenoma," said Dr. Ponchon. "Given excellent preoperative preparation, this treatment is less invasive and more precise than surgery for resecting the ampulla."
Dr. Ponchon cautioned that endoscopic ampullectomy is a difficult procedure that should only be perf
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