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.

Association of metabolic syndromes and risk factors with ampullary tumors development: A case-control study in China

AIM: To evaluate the risk factors for ampullary adenoma and ampullary cancer.

Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions

BACKGROUND The management strategies for recurrent ampullary adenoma after endoscopic papillectomy are still controversial.Patients with the recurrent papillary lesions need to receive repetitive endoscopic interventions due to the limitations of conventional endoscopic techniques.AIM To assess the feasibility,efficacy,and safety of hybrid endoscopic submucosal dissection(ESD)by duodenoscope for recurrent,laterally spreading papillary lesions.METHODS We enrolled two patients with recurrent,laterally spreading,duodenal papillary adenomas with no intraductal extension confirmed by follow-up between March 2017 and September 2018.After marking the resection borders of the lesion using a dual knife,a submucosal cushion was created by injecting a mixture of saline solution,methylene blue,and adrenaline.A total circumferential incision and submucosal excision was performed by dual knife combined with insulated-tip diathermic knife,and then the lesion was ligated and resected using an electric snare.Endoscopic hemostasis was applied during the endoscopic procedures.Moreover,the endoscopic retrograde cholangiopancreatography(ERCP)procedures,including selective cannulation and stent implantation of biliary and pancreatic ducts,were performed.Additionally,we performed endoclip closure for mucosal defect after ESD.RESULTS Hybrid ESD using a duodenoscope and biliary and pancreatic stent placement were performed successfully in two patients.The endoscopic size of recurrent papillary lesions was no more than 2 cm.Generally,the average total procedure time was 95.5 min,and the procedure time of ESD and ERCP was 38.5 min and 15.5 min,respectively.No serious complications occurred during the intraoperative and postoperative periods.The histopathological examination revealed tubulovillous adenoma negative for neoplastic extension at the cut margin in both patients.The duodenoscopic follow-up and histopathology of biopsy specimens at 3 mo after ESD showed no residual or recurrent lesions in ampullary areas in both cases.Both cases have been followed up with no recurrence to June 2020.CONCLUSION Hybrid ESD by duodenoscope is technically challenging,and may be curative for recurrent,laterally spreading papillary adenomas<2 cm.It should be performed cautiously in selected patients by experienced endoscopists.