Endoscopic Papillectomy: A Multi-Center 5-year Retrospective Study

Aims Endoscopic papillectomy has been established as the treatment of option for ampullary adenomas provided that certain criteria are met. Nevertheless, the studies evaluating this technique are limited in the international literature. The purpose of the present study is to evaluate the efficacy and safety of this method, as well as the long-term outcomes.

Methods A retrospective study was conducted including patients undergone an endoscopic papillectomy in the endoscopic departments of 11 greek tertiary centers during the period from January 2019 until November 2024. Parameters taken into account were patients demographics, ampullary adenoma characteristics, rate of complete and definitive resection, adverse events of the procedure, histological findings and recurrence rate of adenomas. In addition, details concerning the procedure (sedation choice, pre-procedural non-steroidal anti-inflammatory drugs usage, duration of the procedure, pancreatic and biliary duct stent placement, resection technique) were collected and analyzed appropriately. For the purpose of the present study, complete resection was defined as the complete adenoma resection without any endoscopic or histological features of residual adenomatous tissue and definitive resection as the complete resection without any evidence of recurrence in the follow-up period [1] [2].

Results We included 116 patients with a mean age of 62,1 years (SD±12,62 y, 54,3% males, 45,7% females). 111 of them underwent an endoscopic papillectomy of major papilla (95,7%) whereas the rest 5 of them a minor papilla resection (4,3%). The mean size of the lesion was 1,75 cm (SD±1,04 cm). Concerning the Vater ampullary adenomas features, the majority of them were confined to ampulla (71,6%, n=83), 14 had an intraductal extension (12,1%), 11 were laterally spreading (9,5%) and 3 of them had both an intraductal presentation and an extra-papillary component (2,6%). The complete resection rate was 83,6%. Complications appeared in 35 patients (30,1%), as follows: pancreatitis (12,1%) was treated conservatively and bleeding (23,3%) was managed endoscopically. One patient required surgery due to perforation (0,9%). For the majority of patients (79,3%, n=92), the final histological review showed a low grade dysplasia adenoma, 12 patients (10,3%) were diagnosed with high grade dysplasia, 2 patients (1,7%) with a carcinoma in situ whereas 8 patients (6,9%) underwent a pancreaticoduodenectomy due to an adenocarcinoma histological result. Recurrence occurred in 14,4% (n=14) of the total number of patients (n=97) who were followed-up for a mean period of 22,21 months (SD±15,33 m). The definitive adenoma resection rate was 76,1% (n=83/109).

Conclusions Endoscopic papillectomy should be considered as an effective method of papillary adenomas resection. Nevertheless, our study demonstrated a correlation with a high rate of bleeding. In most cases, conservative management of adverse events was adequate.

• References

• 1 Spadaccini M, Fugazza A, Frazzoni L. et al. Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis. United European Gastroenterol J 2020; 8 (01): 44-51
• 2 Vanbiervliet G, Strijker M, Arvanitakis M. et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. 2021 53 (04). 429-448