Your browser doesn't support javascript.
loading
Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort.
Vu Trung, Kien; Abou-Ali, Einas; Caillol, Fabrice; Paik, Woo H; Napoleon, Bertrand; Masaryk, Viliam; van der Wiel, Sophia E; Pérez-Cuadrado-Robles, Enrique; Musquer, Nicolas; Halimi, Asif; Soares, Kevin; Souche, Francois R; Seyfried, Steffen; Petrone, Maria C; Crippa, Stefano; Kleemann, Tobias; Albers, David; Weismüller, Tobias J; Dugic, Ana; Meier, Benjamin; Wedi, Edris; Schiemer, Moritz; Regner, Sara; Gaujoux, Sebastien; Hollenbach, Marcus.
Affiliation
  • Vu Trung K; Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany.
  • Abou-Ali E; Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France.
  • Caillol F; Department of Endoscopy, Institut Paoli Calmettes, Marseille, France.
  • Paik WH; Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
  • Napoleon B; Hopital prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France.
  • Masaryk V; Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany.
  • van der Wiel SE; Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands.
  • Pérez-Cuadrado-Robles E; Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France.
  • Musquer N; Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
  • Halimi A; Clinique Santé Atlantique, Saint Herblain, France.
  • Soares K; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
  • Souche FR; Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden.
  • Seyfried S; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
  • Petrone MC; Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
  • Crippa S; Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
  • Kleemann T; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
  • Albers D; Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
  • Weismüller TJ; Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy.
  • Dugic A; Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.
  • Meier B; Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany.
  • Wedi E; Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany.
  • Schiemer M; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.
  • Regner S; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
  • Gaujoux S; Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany.
  • Hollenbach M; Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany.
Endoscopy ; 55(8): 709-718, 2023 08.
Article in En | MEDLINE | ID: mdl-36746390
BACKGROUND: Familial adenomatous polyposis (FAP) is a rare inherited syndrome that predisposes the patient to cancer. Treatment of FAP-related ampullary lesions is challenging and the role of endoscopic papillectomy has not been elucidated. We retrospectively analyzed the outcomes of endoscopic papillectomy in matched cohorts of FAP-related and sporadic ampullary lesions (SALs). METHODS: This retrospective multicenter study included 1422 endoscopic papillectomy procedures. Propensity score matching including age, sex, comorbidity, histologic subtype, and size was performed. Main outcomes were complete resection (R0), technical success, complications, and recurrence. RESULTS: Propensity score matching identified 202 patients (101 FAP, 101 SAL) with comparable baseline characteristics. FAP patients were mainly asymptomatic (79.2 % [95 %CI 71.2-87.3] vs. 46.5 % [95 %CI 36.6-56.4]); P < 0.001). The initial R0 rate was significantly lower in FAP patients (63.4 % [95 %CI 53.8-72.9] vs. 83.2 % [95 %CI 75.8-90.6]; P = 0.001). After repeated interventions (mean 1.30 per patient), R0 was comparable (FAP 93.1 % [95 %CI 88.0-98.1] vs. SAL 97.0 % [95 %CI 93.7-100]; P = 0.19). Adverse events occurred in 28.7 %. Pancreatitis and bleeding were the most common adverse events in both groups. Severe adverse events were rare (3.5 %). Overall, 21 FAP patients (20.8 % [95 %CI 12.7-28.8]) and 16 SAL patients (15.8 % [95 %CI 8.6-23.1]; P = 0.36) had recurrence. Recurrences occurred later in FAP patients (25 [95 %CI 18.3-31.7] vs. 2 [95 %CI CI 0.06-3.9] months). CONCLUSIONS: Endoscopic papillectomy was safe and effective in FAP-related ampullary lesions. Criteria for endoscopic resection of ampullary lesions can be extended to FAP patients. FAP patients have a lifetime risk of relapse even after complete resection, and require long-time surveillance.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Ampulla of Vater / Common Bile Duct Neoplasms / Adenomatous Polyposis Coli Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2023 Type: Article

Full text: 1 Database: MEDLINE Main subject: Ampulla of Vater / Common Bile Duct Neoplasms / Adenomatous Polyposis Coli Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Year: 2023 Type: Article