Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis

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  • Marco Spadaccini
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Alessandro Fugazza
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Leonardo Frazzoni
    Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
  • Milena Di Leo
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Francesco Auriemma
    Gastrointestinal Endoscopy Unit Humanitas Mater Domini Castellanza Italy
  • Silvia Carrara
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Roberta Maselli
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Piera Alessia Galtieri
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Viveksandeep Thoguluva Chandrasekar
    School of Medicine University of Kansas Kansas City USA
  • Lorenzo Fuccio
    Department of Medical and Surgical Sciences S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
  • Emad Aljahdli
    Gastroenterology Unit King Abdul Aziz University Hospital Jeddah Saudi Arabia
  • Cesare Hassan
    Digestive Endoscopy Unit Nuovo Regina Margherita Hospital Rome Italy
  • Prateek Sharma
    School of Medicine University of Kansas Kansas City USA
  • Andrea Anderloni
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy
  • Alessandro Repici
    Digestive Endoscopy Unit Division of Gastroenterology Humanitas Clinical and Research Center Milan Italy

説明

<jats:p>Endoscopic papillectomy (EP) is a viable therapy in ampullary lesions (AL). Many series have reported low morbidity and acceptable outcomes. We performed a systematic review with pooled analysis to assess the safety and efficacy of EP for AL. Electronic databases (Medline, Scopus and EMBASE) were searched up to September 2018. Studies that included patients with endoscopically resected AL were eligible. The rate of adverse events (AEs; primary outcome) and the rates of both technical and clinical efficacy outcomes were pooled by means of a random‐ or fixed‐effects model to obtain a proportion with a 95% confidence interval (CI). Twenty‐nine studies were included (1751 patients). The overall AE rate was 24.9%. The post‐procedural pancreatitis rate was 11.9%, with the only factor affecting this outcome being prophylactic pancreatic stenting. The complete resection rate was 94.2%, with a rate of oncologically curative resection of 87.1%. The recurrence rate was 11.8% (follow‐up: 9.6–84.5 months). EP is a relatively safe and effective option for AL. Our study might definitively suggest the protective role of prophylactic pancreatic stenting against post‐procedural pancreatitis.</jats:p>

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