Transduodenal ampullectomy is an effective surgical exploration procedure in unexplained dilation of cholangiopancreatic duct

Abstract Background The dilation of cholangiopancreatic duct with ambiguous ampullary diseases, named unexplained dilation of cholangiopancreatic duct (UDCD), is a common difficulty in clinical diagnosis and treatment. This study aims to evaluate the applicability of transduodenal ampullectomy (TDA) in the diagnosis and treatment of UDCD. Methods We first proposed the surgical exploration procedure based on TDA and applied it in a representative UDCD patient. Then we retrospectively analyzed the pathological diagnosis and prognosis of 14 patients at our hospital and 181 patients reported by existing studies, who were treated with TDA between January 2010 and December 2022. Results TDA could radically explore the ampullary region and harvest adequate pathological tissue, which was helpful for discovering the cause of UDCD. The diagnostic rate of intraoperative frozen pathology was higher than that of preoperative endoscopic biopsy (78.65% vs 66.42%, P = 0.047). The postoperative complication rate was 31.45%, with mortality 0%. The 5-year survival rate was 72.5% in patients with adenocarcinoma, 91.9% in adenoma with HGD/pTis, and 100% in benign lesions, which have statistically significant difference ( P = 0.012). Conclusions TDA-based surgical exploration can be used as a safe and effective transitional procedure in the treatment of UDCD.