CLINICAL OUTCOMES AFTER ENDOSCOPIC RESECTION OF AMPULLARY ADENOMAS AND LATERALLY SPREADING AMPULLARY LESIONS: A SINGLE-CENTRE RETROSPECTIVE COHORT STUDY

Aims Endoscopic ampullectomy is a relatively high-risk procedure, increasingly performed for adenomatous lesions of the major duodenal papilla. We aimed to determine the procedural outcomes and recurrence rates after endoscopic resection of ampullary adenomas, including both adenomas confined to the ampulla (ACA) and laterally-spreading ampullary lesions (LSALs).

Methods Patients who underwent endoscopic resection of an ampullary adenomatous lesion (April 2014-March 2019) were retrospectively reviewed. LSALs were defined as lesions extending ³10mm beyond the ampullary mound. A single experienced endoscopist (KDP) performed all procedures.

Results We included 26 patients (16 Females, 66.6±17.4 years), of whom 20 had ACA and 6 had an LSAL. The median lesion sizes were 17.6mm, 13.9mm and 30mm, respectively (p=0.002). The en-bloc resection rate was 90% (18/20) in ACAs, whereas all LSALs were resected piecemeal. A small (< 1cm) intraductal adenoma extension was noted in 2 LSALs, snare resected following exposure using an extractor balloon. Six lesions (23.1%) contained foci of high-grade dysplasia (ACA: 10%; LSAL: 66.6%; p= 0.01). Acute pancreatitis occurred in 4 (15.4%) patients (one severe), showing no significant difference between ACAs and LSALs, and between patients undergoing pancreatic duct stenting (n=18) and those who did not. No clinically significant post-procedural bleeding or perforation were noted. The median follow up duration for the entire cohort was 11.5 months. Adenoma recurrence was observed in 8 (30.8%) patients at a median of 11 months after the index procedure (ACA: 20%; LSAL: 66.6%, p=0.05). Lesions resected piecemeal were significantly more likely to recur compared to those resected en-bloc (75% vs 11.1%, p=0.03). All recurrences were managed endoscopically.

Conclusions Endoscopic ampullectomy is effective and can be safely performed in patients with ACAs and LSALs. Early recognition of these lesions, allowing for en-bloc resection, appears to be the main determinant of successful adenoma eradication.