Recurrence rate and management after endoscopic papillectomy in a tertiary referral center

Endoscopic papillectomy (EP) is considered a safe procedure for ampullary lesions. Few data are available on management of residual and recurrent adenomas. The aims of the present study were to evaluate long-term recurrence rate, median time-to-recurrence after EP and treatment of both residual and...

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Bibliographic Details
Published in:Digestive and liver disease Vol. 56; no. 12; pp. 2143 - 2148
Main Authors: Dioscoridi, Lorenzo, Donnarumma, Durante, Forti, Edoardo, Pugliese, Francesco, Cintolo, Marcello, Bonato, Giulia, Bravo, Marianna, Palermo, Andrea, Mutignani, Massimiliano
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01.12.2024
Subjects:
Adenoma - pathology
Adenoma - surgery
Adult
Aged
Aged, 80 and over
Ampulla of Vater - pathology
Ampulla of Vater - surgery
Ampulloma
Common Bile Duct Neoplasms - pathology
Common Bile Duct Neoplasms - surgery
Endoscopic papillectomy
ERCP
Female
Humans
Intraductal radiofrequency
Male
Middle Aged
Neoplasm Recurrence, Local - surgery
Papillary neoplasm
Retrospective Studies
Sphincterotomy, Endoscopic - methods
Tertiary Care Centers
ERCP
Papillary neoplasm
Intraductal radiofrequency
Ampulloma
Endoscopic papillectomy
ISSN:1590-8658, 1878-3562, 1878-3562
Online Access:Get full text
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Summary:Endoscopic papillectomy (EP) is considered a safe procedure for ampullary lesions. Few data are available on management of residual and recurrent adenomas. The aims of the present study were to evaluate long-term recurrence rate, median time-to-recurrence after EP and treatment of both residual and recurrent adenomas. Consecutive patients who underwent EP of major and minor papilla at our endoscopy center between 2011 and 2022 were enrolled. Residual adenoma was defined as the endoscopic evidence of adenomatous tissue after EP. Recurrent adenoma was defined as the presence of adenomatous tissue after the first endoscopic follow-up and complete adenoma resection. 95 patients satisfied the inclusion criteria. Pathology after resection showed adenoma with low-grade dysplasia (LGD) in 52 patients, high-grade dysplasia (HGD) in 25 patients, adenocarcinoma in 6 patients, NET in 4 patients and not-neoplastic duodenal mucosa in 8 patients. Adverse events occurred in 25 % of patients. The median follow-up after EP was 22.5 months. Local residual was observed in 27 patients (28,4 %) and recurrence after the endoscopic retreatments occurred in 11 patients (11,6 %). Furthermore, recurrence occurred in 16 of 68 patients with adenoma-free after a first endoscopic follow-up and 9 patients developed at least a second recurrence. All the recurrences but one were endoscopically treated. EP and its ancillary treatments for residual and recurrent adenomas is an effective treatment for ampullary tumors. Long-term surveillance demonstrates that recurrences can be mainly treated endoscopically.
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ISSN:1590-8658
1878-3562
1878-3562
DOI:10.1016/j.dld.2024.04.037