Published online May 7, 2022. doi: 10.3748/wjg.v28.i17.1845
Peer-review started: September 25, 2021
First decision: November 16, 2021
Revised: November 26, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 7, 2022
Ampullary adenoma is a rare premalignant lesion, but its incidence is increasing. Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness, thereby replacing surgical resection. However, recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30% of cases.
To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.
We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020. We evaluated clinical outcomes and their risk factors. The definitions of outcomes were as follow: (1) curative resection: complete endoscopic resection without recurrence; (2) endoscopic success: treatment of ampullary adenoma with endoscopy without surgical intervention; (3) early recurrence: reconfirmed adenoma at the first endoscopic surveillance; and (4) late recurrence: reconfirmed adenoma after the first endoscopic surveillance.
A total of 106 patients were included for analysis. Of the included patients, 81 (76.4%) underwent curative resection, 99 (93.4%) had endoscopic success, showing that most patients with non-curative resection were successfully managed with endoscopy. Sixteen patients (15.1%) had piecemeal resection, 22 patients (20.8%) had shown positive/uncertain resection margin, 11 patients (16.1%) had an early recurrence, 13 patients (10.4%) had a late recurrence, and 6 patients (5.7%) had a re-recurrence. In multivariate analysis, a positive/uncertain margin [Odds ratio (OR) = 4.023, P = 0.048] and piecemeal resection (OR = 6.610, P = 0.005) were significant risk factors for early and late recurrence, respectively. Piecemeal resection was also a significant risk factor for non-curative resection (OR = 5.424, P = 0.007). Twenty-six patients experienced adverse events (24.5%).
Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas. Careful selection and follow-up of patients is mandatory, particularly in cases with positive/uncertain margin and piecemeal resection.
Core Tip: This is a multi-center study evaluating the clinical outcomes of 106 patients who underwent endoscopic papillectomy for ampullary adenoma. In our results, margin-positive/uncertain pathologic reports and piecemeal resection were significant factors for the curative resection and recurrences. Unexpectedly, many recurrences were observed in margin-negative resection, but in most cases, they were successfully managed with minimally invasive endoscopic therapies. Since there is no definite factor for predicting and preventing recurrence and re-recurrence, regular follow-up with endoscopy should be performed in every patient regardless of resection margin or resection type, especially in patients with margin-positive/uncertain and piecemeal resection.