Background. Ampullary adenomas are premalignant neoplasms and occur in about 0.04 to 0.12% of the general population based on autopsy series. Recently, endoscopic snare papillectomy has increasingly been used with curative intent for ampullary neoplasms.
Methods. Between January 2005 and October 2011, 230 patients with ampullary tumors underwent various surgical operations at our institute: pancreatoduodenectomy (Whipple procedure) — 45, transduodenal papillectomy — 29, palliative surgical operations — 78, endoscopic treatment — 165 cases. Endoscopic treatment of ampullary neoplasms was as following: endoscopic papillectomy — 21 (13%), suprapapillary choledochostomy — 91 (55%), nitinol biliary stenting — 31 (19%), plastic biliary stenting — 22 (13%) cases. En bloc resection of adenoma (< 3 сm) was performed in 10 patients, piecemeal removal (> 3 сm) — in 11 cases. Covered and uncoverd metal stents (1 cm ´ 6 cm) were used in 31 (19%) cases.
Results. Complications of endoscopic papillectomy occurred in 7 cases and were as follows: bleeding — 4, acute mild pancreatitis — 2, perforation — 1. Epinephrine spray and argon-plasma coagulation was used to attain hemostasis in 2 patients, hemoclip placement — in 1 case and angiographic management was necessary in 1 patient. All cases of pancreatitis were treated conservatively. In 1 case of perforation surgery was performed. During follow-up (mean 30 months) 12 of 21 patients (49%) had no recurrence, 5 — had recurrent adenoma (mean time interval to recurrence 27 months), two died of unrelated illnesses and 2 are awaiting follow-up. All residual tumors were eradicated by repeated endoscopic procedures.