[Palliative endoscopic treatment of adenocarcinoma of Vater's ampulla: medium and long-term results]

The palliative endoscopic treatment of tumors of the ampulla of Vater provides good short-term symptomatic results, while long-term results remain unknown. This study to assessed the course of 17 patients with carcinoma of the ampulla of Vater treated palliatively by endoscopy and monitored for a 5-year-period. From january 1985 to december 1989, 35 patients were diagnosed as having carcinoma of the ampulla of Vater. For 18 of them, curative surgery was performed, while for the 17 remaining 17 patients, palliative endoscopic treatment was proposed because of metastatic extension or surgical risk. Endoscopic treatment always included endoscopic sphincterotomy, and, in some cases, insertion of a biliary endoprosthesis. All patients were monitored until death or the end of follow-up on September 30, 1990. Endoscopic sphincterotomy was performed in 13 of the 17 patients, either alone in 10 cases, or with prosthesis in the other 3 cases. For the 4 other patients, endoscopic sphincterotomy could not be performed (large tumor in 2 cases, presence of duodenal diverticulum in 2 other cases). The 13 patients who underwent endoscopic treatment experienced rapid symptomatic improvement. Jaundice and cholangitis consistently recurred within a period of 1 to 44 weeks regardless of initial treatment. All recurrences except one, were successfully retreated by endoscopy (enlargement of initial sphincterotomy in 6 cases, insertion or replacement of prosthesis in 12 cases).(ABSTRACT TRUNCATED AT 250 WORDS)