Long-Term Outcomes of Endoscopic Papillectomy for Ampullary Adenomas

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2019 Aug 30

PMID 31463668

Citations 17

Authors

Nadav Sahar

Rajesh Krishnamoorthi

Richard A Kozarek

Michael Gluck

Michael Larsen

Andrew S Ross

Shayan Irani

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas and has mostly replaced surgical local resection. Recent data have discussed the role of endoscopic removal of laterally spreading adenomas associated with ampullary adenomas. We evaluated our long-term results of endoscopic papillectomy for ampullary adenomas.

Methods: We retrospectively analyzed patients who underwent endoscopic papillectomy of biopsy-proven adenomas at our tertiary center between 1994 and 2017. Clinical success was defined as complete excision of an adenoma with no evidence of recurrence during follow-up, no evidence of cancer, and without the need for surgery.

Results: A total of 161 patients (73M/88F) with a mean age of 61 (range 19-93) were included. Mean adenoma size was 20 mm (range 5-70). In total, 114/161 patients continued endoscopic surveillance for a minimum of 6 months with a median follow-up of 30 months (range 6-283). Recurrent adenomas were diagnosed in 8 patients (7%) after a median of 36 months (range 12-138). Clinical success was 83%; 35 laterally spreading adenomas were treated, which were larger than adenomas confined to the papilla (mean size 38 mm vs 15 mm, P < 0.05) and required more piecemeal resections (77% vs 15%, P < 0.05). However, no difference was found in recurrence rates between the two groups (8% vs 4%, P = 0.26); 24/161 (15%) of patients had adverse events including bleeding (6%) and pancreatitis (7%).

Conclusions: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas, including laterally spreading ones. Long-term surveillance demonstrates low recurrence rates at expert centers.

Citing Articles

Modified Endoscopic Submucosal Dissection-An Alternative Modality for the Treatment of Sporadic Duodenal Papillary Adenomas.

Han Z, Li Q, Chua C, Wang Z, Zhong J, Huang Y Gastroenterol Res Pract. 2024; 2024:7444677.

PMID: 39450283 PMC: 11502125. DOI: 10.1155/2024/7444677.

Effectiveness of endoscopic papillectomy with stent placement in pancreatic and bile ducts for treating duodenal papillary adenoma: a retrospective study.

Jiang J, Lv F, Chen C, Jiang W BMC Gastroenterol. 2024; 24(1):379.

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New Method of Papillectomy May Decrease Recurrence: Anchoring Method versus Conventional Method.

Lee J, Park Y, Han S, Joo D, Hong S, Yi K J Clin Med. 2024; 13(11).

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Long-term Outcomes of Ampullary Adenoma According to Resected Margin Status after Endoscopic Papillectomy.

Lee J, Oh D, Seo D, Song T, Park D, Lee S Gut Liver. 2024; 18(4):747-755.

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Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis.

Landim D, Hourneaux de Moura D, Hirsch B, Peixoto de Oliveira G, de Oliveira Veras M, Giacobo Nunes F Endosc Int Open. 2024; 12(3):E440-E447.

PMID: 38550766 PMC: 10978094. DOI: 10.1055/a-2226-0928.

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