Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up

Aims. To compare the efficacy and the complication rate between endoscopic snare resection of adenomas of Vater's papilla and endoscopic palliation. Methods, In a retrospective, non randomized manner, we compared long-term r esults of our endoscopic strategies in 36 patients with histologically conf irmed adenoma of Vater's papilla submitted either to local endoscopic snare resection (n=18) or to simple endoscopic palliation (n=18), respectively. Results, Between 1985 and 1998 results were reviewed. Median age was 76.5 ( range 42-89) years in the palliation, and 64.0 (23-89) years in the endosco pic snare resection group. Median duration of follow-up was 33 [6-135] and 75.0 (27-123) months, respectively. The incidence of adenocarcinoma of Vate r's papilla was I per 52.8 patient-years after endoscopic snare resection a nd I per 15.5 patient-years in the group treated with endoscopic palliation . Compared to the results of endoscopic palliation (prosthesis, sphincterot omy), we found a significant reduction of carcinoma-related death (p=0.0045 , McNemar) and adenoma carcinoma-sequence (p=0.007, McNemar) after snare re section. Conclusions, This retrospective study suggests that complete endoscopic sna re resection of adenomas of Vater's papilla will lead to a lower rate of ad enoma-carcinoma sequence, to a lower carcinoma-related death rate and proba bly improves patient survival. These results should be proven prospectively .