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Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study

BACKGROUND: Ampullary adenoma is a rare premalignant lesion, but its incidence is increasing. Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness, thereby replacing surgical resection. However, recurrence rates and adverse event...

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Autores principales: Choi, Seong Ji, Lee, Hong Sik, Kim, Jiyeong, Choe, Jung Wan, Lee, Jae Min, Hyun, Jong Jin, Yoon, Jai Hoon, Kim, Hyo Jung, Kim, Jae Seon, Choi, Ho Soon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099193/
https://www.ncbi.nlm.nih.gov/pubmed/35633905
http://dx.doi.org/10.3748/wjg.v28.i17.1845
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author Choi, Seong Ji
Lee, Hong Sik
Kim, Jiyeong
Choe, Jung Wan
Lee, Jae Min
Hyun, Jong Jin
Yoon, Jai Hoon
Kim, Hyo Jung
Kim, Jae Seon
Choi, Ho Soon
author_facet Choi, Seong Ji
Lee, Hong Sik
Kim, Jiyeong
Choe, Jung Wan
Lee, Jae Min
Hyun, Jong Jin
Yoon, Jai Hoon
Kim, Hyo Jung
Kim, Jae Seon
Choi, Ho Soon
author_sort Choi, Seong Ji
collection PubMed
description BACKGROUND: Ampullary adenoma is a rare premalignant lesion, but its incidence is increasing. Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness, thereby replacing surgical resection. However, recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30% of cases. AIM: To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes. METHODS: We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020. We evaluated clinical outcomes and their risk factors. The definitions of outcomes were as follow: (1) curative resection: complete endoscopic resection without recurrence; (2) endoscopic success: treatment of ampullary adenoma with endoscopy without surgical intervention; (3) early recurrence: reconfirmed adenoma at the first endoscopic surveillance; and (4) late recurrence: reconfirmed adenoma after the first endoscopic surveillance. RESULTS: A total of 106 patients were included for analysis. Of the included patients, 81 (76.4%) underwent curative resection, 99 (93.4%) had endoscopic success, showing that most patients with non-curative resection were successfully managed with endoscopy. Sixteen patients (15.1%) had piecemeal resection, 22 patients (20.8%) had shown positive/uncertain resection margin, 11 patients (16.1%) had an early recurrence, 13 patients (10.4%) had a late recurrence, and 6 patients (5.7%) had a re-recurrence. In multivariate analysis, a positive/uncertain margin [Odds ratio (OR) = 4.023, P = 0.048] and piecemeal resection (OR = 6.610, P = 0.005) were significant risk factors for early and late recurrence, respectively. Piecemeal resection was also a significant risk factor for non-curative resection (OR = 5.424, P = 0.007). Twenty-six patients experienced adverse events (24.5%). CONCLUSION: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas. Careful selection and follow-up of patients is mandatory, particularly in cases with positive/uncertain margin and piecemeal resection.
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spelling pubmed-90991932022-05-26 Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study Choi, Seong Ji Lee, Hong Sik Kim, Jiyeong Choe, Jung Wan Lee, Jae Min Hyun, Jong Jin Yoon, Jai Hoon Kim, Hyo Jung Kim, Jae Seon Choi, Ho Soon World J Gastroenterol Retrospective Study BACKGROUND: Ampullary adenoma is a rare premalignant lesion, but its incidence is increasing. Endoscopic papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness, thereby replacing surgical resection. However, recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30% of cases. AIM: To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes. METHODS: We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and 2020. We evaluated clinical outcomes and their risk factors. The definitions of outcomes were as follow: (1) curative resection: complete endoscopic resection without recurrence; (2) endoscopic success: treatment of ampullary adenoma with endoscopy without surgical intervention; (3) early recurrence: reconfirmed adenoma at the first endoscopic surveillance; and (4) late recurrence: reconfirmed adenoma after the first endoscopic surveillance. RESULTS: A total of 106 patients were included for analysis. Of the included patients, 81 (76.4%) underwent curative resection, 99 (93.4%) had endoscopic success, showing that most patients with non-curative resection were successfully managed with endoscopy. Sixteen patients (15.1%) had piecemeal resection, 22 patients (20.8%) had shown positive/uncertain resection margin, 11 patients (16.1%) had an early recurrence, 13 patients (10.4%) had a late recurrence, and 6 patients (5.7%) had a re-recurrence. In multivariate analysis, a positive/uncertain margin [Odds ratio (OR) = 4.023, P = 0.048] and piecemeal resection (OR = 6.610, P = 0.005) were significant risk factors for early and late recurrence, respectively. Piecemeal resection was also a significant risk factor for non-curative resection (OR = 5.424, P = 0.007). Twenty-six patients experienced adverse events (24.5%). CONCLUSION: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas. Careful selection and follow-up of patients is mandatory, particularly in cases with positive/uncertain margin and piecemeal resection. Baishideng Publishing Group Inc 2022-05-07 2022-05-07 /pmc/articles/PMC9099193/ /pubmed/35633905 http://dx.doi.org/10.3748/wjg.v28.i17.1845 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Choi, Seong Ji
Lee, Hong Sik
Kim, Jiyeong
Choe, Jung Wan
Lee, Jae Min
Hyun, Jong Jin
Yoon, Jai Hoon
Kim, Hyo Jung
Kim, Jae Seon
Choi, Ho Soon
Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title_full Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title_fullStr Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title_full_unstemmed Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title_short Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study
title_sort clinical outcomes of endoscopic papillectomy of ampullary adenoma: a multi-center study
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099193/
https://www.ncbi.nlm.nih.gov/pubmed/35633905
http://dx.doi.org/10.3748/wjg.v28.i17.1845
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