Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up.

ABSTRACT

BACKGROUND: Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. OBJECTIVE: To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENTS All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. INTERVENTION Endoscopic papillectomy. MAIN OUTCOME MEASUREMENTS Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. RESULTS: We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P = .009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P = .002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P = .011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P = .001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. LIMITATIONS: Retrospective analysis. CONCLUSION: Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.