Clinical outcomes: endoscopic resection of duodenal ampullary lesions

Stephanie M Woo; Mark J Real; Brett M Will; Eric J Kim; Jiling Chou; Ahmed A Alsaiari; Ahmad Nakshabandi; Walid M Chalhoub; Nadim G Haddad

doi:10.21037/tgh-22-87

Clinical outcomes: endoscopic resection of duodenal ampullary lesions

Transl Gastroenterol Hepatol. 2023 Feb 22:8:15. doi: 10.21037/tgh-22-87. eCollection 2023.

Authors

Stephanie M Woo^{1

2}, Mark J Real¹, Brett M Will^{2

3}, Eric J Kim^{3

4}, Jiling Chou⁵, Ahmed A Alsaiari^{1

6}, Ahmad Nakshabandi^{1

7}, Walid M Chalhoub¹, Nadim G Haddad¹

Affiliations

¹ Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA.
² Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
³ Georgetown University School of Medicine, Washington, DC, USA.
⁴ Department of Anesthesiology, MedStar Georgetown University Hospital, Washington, DC, USA.
⁵ MedStar Health Research Institute, Hyattsville, MD, USA.
⁶ Department of Internal Medicine, Jeddah University, Jeddah, Saudi Arabia.
⁷ Department of Gastroenterology, UT MD Anderson Cancer Center, Houston, TX, USA.

Abstract

Background: Ampullary adenomas are lesions at the duodenum's major papilla commonly associated with familial adenomatous polyposis (FAP) but may also occur sporadically. Historically, ampullary adenomas were removed surgically, however endoscopic resection has become the preferred method of resection. Most of the literature on management of ampullary adenomas are small single-center retrospective reviews. The objective of this study is to describe endoscopic papillectomy outcomes to further refine management guidelines.

Methods: This is a retrospective study of patients who underwent endoscopic papillectomy. Demographic data were included. Details regarding lesions and procedures were also collected, including endoscopic impression, size, resection method and adjunctive therapies. Chi-square, Kruskal-Wallis rank-sum, and t-tests were performed.

Results: A total of 90 patients were included. 60% patients (54 of 90) had pathology-proven adenomas. 14.4% of all lesions (13 of 90) and 18.5% of adenomas (10 of 54) were treated with APC. Among APC-treated lesions, 36.4% developed recurrence (4 of 11) vs. 7.1% developed residual lesion (1 of 14) (P=0.019). 15.6% of all lesions (14 of 90) and 18.5% of adenomas (10 of 54) reported complications, and the most common was pancreatitis (11.1% and 5.6%). Median follow-up time was 8 months for all lesions and 14 months (range, 1-177 months) for adenomas, with time to recurrence 30 and 31 months (range, 1-137 months), respectively. Recurrence was observed in 16.7% of all lesions (15 of 90) and 20.4% of adenomas (11 of 54). Endoscopic success was observed in 69.2% of all lesions (54 of 78) and 71.4% of adenomas (35 of 49) after removing patients lost to follow-up.

Conclusions: Endoscopic papillectomy is an effective method for managing duodenal adenomas. Pathology-proven adenoma should undergo surveillance for at least 31 months. Lesions treated with APC may require closer follow-up and for a prolonged period.

Keywords: Duodenal adenoma; ampullectomy; ampulloma; papillectomy.