A WORKING ALGORITHM FOR THE MANAGEMENT OF TUMOURS OF THE AMPULLA OF VATER

Aim: The aim of this study is to access the integration of endoscopic and surgical resection in the definitive management of patients with tumours of the AoV based on tumour size through a prospective analytical study. Patients and methods: A cohort of 15 consecutive patients with papillary neoplasms formed the study population. Patients ivith tumours ≤ 4 cm were offered endoscopic resection while patients with tumours 4 cm were offered a pancreaticoduodenectomy after a short period of preoperative biliary stenting. Patients in the endoscopic and surgical groups underwent duodenoscopic or imaging surveillance, respectively, at their follow-up visits. Results: The median age of the study population was 43 years (min - max: 30 - 80) with a male to female ratio of 3 : 2. Nine (60%) patients ivere found legible for endoscopic ampullectomy while the remaining six (40%) had a short period of preoperative biliary drainage followed by pancreaticoduodenectomy. In the endoscopy group, three patients required two sessions to obtain tumour free margins and one patient developed pancreatitis. In the surgery group, one patient suffered from an anastomotic biliary stricture requiring redo surgery. After a median of 15.3 (min - max: 4.67-39.5) months of follow-up all patients were living with no endoscopic or imaging evidence of tumour recurrence. Conclusion: Pancreatoduodenectomy remains the treatment of choice for large and malignant tumours while endoscopic resection with close follow-up for two years seems to be adequate for sinall size tumours