Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study

BACKGROUND 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.AIM To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.METHODS 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.RESULTS 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 noncurative 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%).CONCLUSION 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.