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Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions.

ABSTRACT: Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8-81.4%, I² = 91.38%) for EA, 96.4% (93.6-99.2%, I² = 37.8%) for SA and 98.9% (98.0-99.7%, I² = 0%) for PD. AEs were 24.7% (19.8-29.6%, I² = 86.4%), 28.3% (19.0-37.7%, I² = 76.8%) and 44.7% (37.9-51.4%, I² = 0%), respectively. Recurrences were registered in 13.0% (10.2-15.6%, I² = 91.3%), 9.4% (4.8-14%, I² = 57.3%) and 14.2% (9.5-18.9%, I² = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.

SUBMITTER: Heise C

PROVIDER: S-EPMC7696506 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions.

Heise Christian C Abou Ali Einas E Hasenclever Dirk D Auriemma Francesco F Gulla Aiste A Regner Sara S Gaujoux Sébastien S Hollenbach Marcus M

Journal of clinical medicine 20201110 11

Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and ...[more]

PMID: 33182806

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Project description:Background and aimsDuodenal polyps have a reported incidence of 0.3% to 4.6%. Sporadic, nonampullary duodenal adenomas (SNDAs) comprise less than 10% of all duodenal polyps, and ampullary adenomas are even less common. Nonetheless, the incidence continues to rise because of widespread endoscopy use. Duodenal polyps with villous features or those that are larger than 10 mm may raise concern for malignancy and require removal. We demonstrate endoscopic resection of SNDAs and ampullary adenomas using some of our preferred techniques.MethodsThe duodenum has several components that can make EMR of duodenal polyps technically challenging. Not only does the duodenum have a thin muscle layer, but it is also highly mobile and vascular, which may explain higher rates of perforation and bleeding of duodenal EMR reported in the literature compared with colon EMR. A standard adult gastroscope with a distal cap is commonly used for duodenal EMRs. Based on the location, however, side-viewing duodenoscopes or pediatric colonoscopes may be used. To prepare for EMR, a submucosal injection is performed for an adequate lift. The polyp is then resected via stiff monofilament snares and subsequently closed with hemostatic clips if feasible. The ampullectomy technique differs slightly from duodenal EMRs and carries the additional risk of pancreatitis. Submucosal injection in the ampulla may not lift well; thus, its utility is debatable. Biliary sphincterotomy should be performed, and based on endoscopist preference, the pancreatic duct (PD) guidewire can be left during resection to maintain access. After resection, a PD stent is placed to minimize pancreatitis risk.ResultsThe video shows the aforementioned duodenal EMR techniques. Two clips of ampullectomy are also shown in the video.ConclusionsA few common techniques used to perform duodenal EMR and ampullectomy are highlighted in the video. It is important to understand and manage adverse events associated with these procedures and to have established surveillance plans.

Dataset Information

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions.

Publications

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions.

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