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
The incidence of ampullary adenoma (AA) is increasing, partly from increasing number of imaging studies and from true increase in incidence. Because of its malignant potential, AA has to be removed either surgically or endoscopically.
The role of endoscopic papillectomy (EP) in treatment of AA has been growing due to its relatively low invasiveness, but recurrences and side effects are reported in up to 30% of cases.
Our study aimed to evaluate the clinical outcomes of EP in patients with AA, performed at five tertiary hospitals.
We collected the clinical data of patients with AA who underwent EP at five tertiary hospitals between 2013 and 2020 and analyzed the clinical outcomes and adverse events. Clinical outcomes were curative resection, defined as complete endoscopic resection without recurrence, endoscopic success, defined as treatment of ampullary adenoma with endoscopy alone, and recurrence, defined reconfirmed adenoma in endoscopy. Recurrence was divided into early and late, based on an interval of 6 mo.
Among 106 patients included, curative resection was achieved in 81 patients (76.4%), endoscopic success was achieved in 99 patients (93.4%), early recurrence was identified in 11 patients (16.1%), and late recurrence was identified in 13 patients, and re-recurrence was identified in 6 patients (12.3%). In multivariate analysis, the risk of early and late recurrences was significantly increased in a positive/uncertain margin and piecemeal resection, respectively. The risk of non-curative resection was significantly increased in piecemeal resection. Twenty-six patients experienced adverse events (24.5%): 14 pancreatitis, 11 delayed bleeding, 6 cholangitis, and 1 perforation.
EP is a relatively safe procedure with high endoscopic success rate. Due to the diagnostic discrepancy, recurrence, re-recurrence and adverse events, careful selection and follow-up of patients are also needed.
A positive/uncertain margin and piecemeal resection were significant risk factors for poor outcomes; therefore, every effort should be made to ensure adequate free margin and to perform en-bloc resection during EP.