Abstract
Carcinoids of the ampulla: Long-term follow-up after endoscopic resection
Journal of clinical oncology, Vol.37(4_suppl), pp.430-430
02/01/2019
DOI: 10.1200/JCO.2019.37.4_suppl.430
Abstract
430
Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.
Details
- Title: Subtitle
- Carcinoids of the ampulla: Long-term follow-up after endoscopic resection
- Creators
- George Nyasha Baison - Virginia Mason Medical CenterNadav Sahar - Virginia Mason Medical CenterMorgan M Bonds - Virginia Mason Medical CenterJanelle F Rekman - Virginia Mason Medical CenterFlavio G. Rocha - Virginia Mason Medical CenterShayan Irani - Virginia Mason Medical Center
- Resource Type
- Abstract
- Publication Details
- Journal of clinical oncology, Vol.37(4_suppl), pp.430-430
- DOI
- 10.1200/JCO.2019.37.4_suppl.430
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 02/01/2019
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984363300802771
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