Endoscopic Papillectomy for Ampullary Adenomas: Different Outcomes in Sporadic Tumors and Those Associated with Familial Adenomatous Polyposis

Paolo Cecinato, Francesca Parmeggiani, Luca Braglia, Gabriele Carlinfante, Ramona Zecchini, Francesco Decembrino, Veronica Iori, Giuliana Sereni, Cristiana Tioli, Maurizio Cavina, Lorenzo Camellini, Francesco Azzolini, Maurizio Ponz de Leon, Romano Sassatelli

Research output: Contribution to journalArticle

Abstract

Background: Ampullary adenomas are rare and potentially malignant. Surgery was the standard treatment but endoscopic papillectomy (EP) is a possible alternative. Aim: We retrospectively evaluated the principal clinical outcomes of EP in all patients referred to our unit also dividing sporadic ampullary adenoma (SAA) from familial adenomatous polyposis (FAP)–associated adenomas. Methods: All consecutive patients who underwent endoscopic papillectomy because of ampullary adenoma were considered. The primary outcome was the technical success of EP. Secondary outcomes included the number of procedures, the adverse event rate, the recurrence rate, the concordance of histology pre- and post-EP, and the evaluation of factors related to technical success. Results: Between January 2001 and December 2015, sixty-two patients were included (21 FAP and 41 SAA). Technical success was achieved in 75.8% and was different in the two groups (FAP 95.2%, SAA 65.8%, p 0.025). Intraductal invasion was negatively associated with technical success (41.7% vs. 84.0%; p 0.005). The intestinal subtype was predictive of success (79.7% vs. 0%; p 0.012) as well as en bloc resection (90.3% vs. 61.3%; p 0.016). Adverse events were reported in 14 patients (22.6%). Conclusions: EP is an effective and safe procedure and is a viable alternative to surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT03494543

Original languageEnglish
JournalJournal of Gastrointestinal Surgery
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Ampullary adenomas
  • Ampullary carcinoma
  • Endoscopic papillectomy
  • Familial adenomatous polyposis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Cecinato, P., Parmeggiani, F., Braglia, L., Carlinfante, G., Zecchini, R., Decembrino, F., Iori, V., Sereni, G., Tioli, C., Cavina, M., Camellini, L., Azzolini, F., Ponz de Leon, M., & Sassatelli, R. (Accepted/In press). Endoscopic Papillectomy for Ampullary Adenomas: Different Outcomes in Sporadic Tumors and Those Associated with Familial Adenomatous Polyposis. Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-019-04500-w