Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2022; 28(17): 1845-1859
Published online May 7, 2022. doi: 10.3748/wjg.v28.i17.1845
Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
Seong Ji Choi, Hong Sik Lee, Jiyeong Kim, Jung Wan Choe, Jae Min Lee, Jong Jin Hyun, Jai Hoon Yoon, Hyo Jung Kim, Jae Seon Kim, Ho Soon Choi
Seong Ji Choi, Jai Hoon Yoon, Ho Soon Choi, Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, South Korea
Hong Sik Lee, Jung Wan Choe, Jae Min Lee, Jong Jin Hyun, Hyo Jung Kim, Jae Seon Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea
Jiyeong Kim, Lab of Biostatistical Consulting and Research, Medical Research Collaborating Center, Industry-University Cooperation Foundation, Hanyang University, Seoul 04763, South Korea
Author contributions: Choi SJ and Lee HS carried out the concept and design, drafting of the article, and critical revision; Choe JW, Lee JM, Hyun JJ, and Yoon JH collected the data; Kim J, Kim HJ, Kim JS, Choi HS carried out data analysis and interpretation; and all authors approved the final version of the article.
Supported by National Research Foundation of Korea grant funded by the Korean Government, No. NRF-2021M3E5D1A01015177; and National Research Foundation of Korea grant funded by the Ministry of Education, No. NRF-2018R1D1A1B07048202.
Institutional review board statement: The study protocol was consistent with the guidelines outlined in the Declaration of Helsinki and was approved by the institutional review boards of each participating institution.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Authors declare no conflict of interest in this article.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Sik Lee, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, South Korea. hslee60@korea.ac.kr
Received: September 25, 2021
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
Processing time: 215 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

Our study aimed to evaluate the clinical outcomes of EP in patients with AA, performed at five tertiary hospitals.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.