Incidence and risk factors for recurrence of ampullary adenomas after endoscopic papillectomy: Comparative analysis of familial adenomatous polyposis and sporadic ampullary adenomas in an international multicenter cohort

Authors

Achintya D. Singh, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Carol A. Burke, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
Peter V. Draganov, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA.
Jay Bapaye, Rochester Regional HealthFollow
Makoto Nishimura, Division of Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Saowanee Ngamruengphong, Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Vladimir Kushnir, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Neil Sharma, Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA.
Vivek Kaul, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, USA.
Aparajita Singh, Department of Gastroenterology, University of California, San Francisco, CA, USA.
Amol Bapaye, Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Debdeep Banerjee, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA.
Alexis Bayudan, Department of Gastroenterology, University of California, San Francisco, CA, USA.
Mariajose Rojas De Leon, Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA.
Ritu R. Singh, Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA.
Shruti Mony, Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Ashish Gandhi, Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Thomas Hollander, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Krystle Bittner, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, USA.
Jacques Beauvais, Division of Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ruishen Lyu, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
David Liska, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Tyler Stevens, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
Matthew Walsh, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
Amit Bhatt, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.

Department

Internal Medicine

Document Type

Article

Publication Title

Digestive Endoscopy

Abstract

OBJECTIVES: Endoscopic papillectomy (EP) is a minimally invasive therapy for the management of ampullary adenomas (AA). We conducted this multicenter study to assess the incidence of and factors related to the recurrence of AA after EP in patients with familial adenomatous polyposis (FAP) compared to sporadic AA.

METHODS: We included patients who underwent EP for AA at 10 tertiary hospitals. Adenomatous tissue at the resection site at the time of surveillance endoscopies was considered recurrent disease.

RESULTS: In all, 257 patients, 100 (38.9%) with FAP and 157 (61%) patients with sporadic AA, were included. Over a median of 31 (range, 11-61) months, recurrence occurred in 48/100 (48%) of patients with FAP and 58/157 (36.9%) with sporadic AA (P = 0.07). Two (2%) FAP patients and 10 (6.3%) patients with sporadic AA underwent surgery for recurrence. On multivariable regression analysis, the recurrence in FAP was higher than in sporadic patients after the first year of follow-up. AA size (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.001, 1.056), periampullary extension (HR 2.5, 95% CI 1.5, 4.01), and biliary duct dilation (HR 2.04, 95% CI 1.2, 3.4) increased the risk, while en bloc resection (HR 0.6, 95% CI 0.41, 0.9) decreased the risk of recurrence.

CONCLUSION: Recurrence rates are high after EP. Most recurrences in sporadic patients occur within the first year of follow-up, but after the first year of follow-up in patients with FAP. Recurrences are higher with larger adenomas, biliary duct dilation, and periampullary extensions, and may be mitigated by en bloc resection. These factors should be considered in decision-making with the patients.

First Page

834

Last Page

842

DOI

10.1111/den.14725

Volume

36

Issue

7

Publication Date

7-1-2024

Medical Subject Headings

Humans; Male; Female; Adenomatous Polyposis Coli (surgery, pathology); Ampulla of Vater (surgery, pathology); Neoplasm Recurrence, Local (epidemiology); Common Bile Duct Neoplasms (surgery, pathology); Incidence; Middle Aged; Risk Factors; Adenoma (surgery, pathology); Retrospective Studies; Sphincterotomy, Endoscopic; Adult; Aged; Follow-Up Studies

PubMed ID

37985239

Recommended Citation

Singh, A. D., Burke, C. A., Draganov, P. V., Bapaye, J., Nishimura, M., Ngamruengphong, S., Kushnir, V., Sharma, N., Kaul, V., Singh, A., Bapaye, A., Banerjee, D., Bayudan, A., De Leon, M. R., Singh, R. R., Mony, S., Gandhi, A., Hollander, T., Bittner, K., Beauvais, J., Lyu, R., Liska, D., Stevens, T., Walsh, M., & Bhatt, A. (2024). Incidence and risk factors for recurrence of ampullary adenomas after endoscopic papillectomy: Comparative analysis of familial adenomatous polyposis and sporadic ampullary adenomas in an international multicenter cohort. Digestive Endoscopy, 36 (7), 834-842. https://doi.org/10.1111/den.14725