BACKGROUND: Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. OBJECTIVE: To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENTS: All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. INTERVENTION: Endoscopic papillectomy. MAIN OUTCOME MEASUREMENTS: Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. RESULTS: We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P = .009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P = .002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P = .011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P = .001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. LIMITATIONS: Retrospective analysis. CONCLUSION: Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.
BACKGROUND: Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. OBJECTIVE: To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENTS: All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. INTERVENTION: Endoscopic papillectomy. MAIN OUTCOME MEASUREMENTS: Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. RESULTS: We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P = .009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P = .002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P = .011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P = .001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. LIMITATIONS: Retrospective analysis. CONCLUSION:Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.
Authors: P B Cotton; G Lehman; J Vennes; J E Geenen; R C Russell; W C Meyers; C Liguory; N Nickl Journal: Gastrointest Endosc Date: 1991 May-Jun Impact factor: 9.427
Authors: Eugene P Ceppa; Rebecca A Burbridge; Kristy L Rialon; Philip A Omotosho; Dawn Emick; Paul S Jowell; Malcom Stanley Branch; Theodore N Pappas Journal: Ann Surg Date: 2013-02 Impact factor: 12.969
Authors: S M M de Castro; N T van Heek; K F D Kuhlmann; O R C Busch; G J A Offerhaus; T M van Gulik; H Obertop; D J Gouma Journal: Surgery Date: 2004-11 Impact factor: 3.982
Authors: Chi-Liang Cheng; Stuart Sherman; Evan L Fogel; Lee McHenry; James L Watkins; Toyomi Fukushima; Thomas J Howard; Laura Lazzell-Pannell; Glen A Lehman Journal: Gastrointest Endosc Date: 2004-11 Impact factor: 9.427
Authors: Wiriyaporn Ridtitid; Suzette E Schmidt; Mohammad A Al-Haddad; Julia LeBlanc; John M DeWitt; Lee McHenry; Evan L Fogel; James L Watkins; Glen A Lehman; Stuart Sherman; Gregory A Coté Journal: Gastrointest Endosc Date: 2014-10-05 Impact factor: 9.427
Authors: Nadav Sahar; Rajesh Krishnamoorthi; Richard A Kozarek; Michael Gluck; Michael Larsen; Andrew S Ross; Shayan Irani Journal: Dig Dis Sci Date: 2019-08-28 Impact factor: 3.199
Authors: Enrique Pérez-Cuadrado-Robles; Hubert Piessevaux; Tom G Moreels; Ralph Yeung; Tarik Aouattah; Mina Komuta; Hélène Dano; Anne Jouret-Mourin; Pierre H Deprez Journal: United European Gastroenterol J Date: 2019-01-12 Impact factor: 4.623
Authors: E Soons; T M Bisseling; M C A van Kouwen; G Möslein; P D Siersema Journal: United European Gastroenterol J Date: 2021-05-07 Impact factor: 4.623