Post written by Anand Kumar, MD, MPH, from Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

We compared outcomes such as rates of histologic negative margins, procedure times, and recurrence of underwater ampullectomy (UA) with traditional (gas insufflation) ampullectomy (TA) for polyps involving the ampulla.

Underwater resection has proven advantages of higher en bloc resection, lower recurrence, and faster procedure time for polyps in the colon and duodenum. However, there are no data on outcomes of UA or comparison data of UA versus TA.

A total of 37 patients (11 UA, 26 TA) made this the largest reported study on UA, to our knowledge. There are no prior published comparison studies of UA versus TA.

UA achieved significantly higher negative histological margins (72.7% vs 30.8%) and faster procedure times (66.8 minutes vs 82.5 minutes) compared with TA. Recurrences were numerically lower (15.4% vs 18.2%) with UA than with TA, but this did not reach statistical significance. When intraductal extension and cancers were excluded, some of these differences were amplified, such as 100% negative histologic margins with UA compared with 26.3% with TA.

Bar chart depicting the proportion of en bloc resections with negative margins (NMR) achieved with underwater ampullectomy (UA) versus traditional ampullectomy (TA). UA: 72.7%; TA: 30.8%. Error bars represent 95% confidence intervals. Extn., extension.

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