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Endoscopic versus surgical treatment of ampullary adenomas: a systematic review and meta-analysis
Mendonça, Ernesto Quaresma; Bernardo, Wanderley Marques; Moura, Eduardo Guimarães Hourneaux de; Chaves, Dalton Marques; Kondo, André; Pu, Leonardo Zorrón Cheng Tao; Baracat, Felipe Iankelevich.
  • Mendonça, Ernesto Quaresma; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Bernardo, Wanderley Marques; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Moura, Eduardo Guimarães Hourneaux de; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Chaves, Dalton Marques; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Kondo, André; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Pu, Leonardo Zorrón Cheng Tao; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
  • Baracat, Felipe Iankelevich; Faculdade de Medicina da Universidade de São Paulo. Gastroenterologia. Unidade de Endoscopia Gastrointestinal. São Paulo. BR
Clinics ; 71(1): 28-35, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-771946
ABSTRACT
The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas. A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model. Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23). Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different.
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Full text: Available Index: LILACS (Americas) Main subject: Ampulla of Vater / Adenoma / Common Bile Duct Neoplasms / Duodenal Neoplasms / Endoscopy Type of study: Practice guideline / Observational study / Risk factors / Systematic reviews Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2016 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina da Universidade de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Ampulla of Vater / Adenoma / Common Bile Duct Neoplasms / Duodenal Neoplasms / Endoscopy Type of study: Practice guideline / Observational study / Risk factors / Systematic reviews Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2016 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina da Universidade de São Paulo/BR