Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up

Abstract

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.

Keywords: FAP; PEP; familial adenomatous polyposis; post-ERCP pancreatitis.