Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, South Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea.
World J Gastroenterol. 2022 May 7;28(17):1845-1859. doi: 10.3748/wjg.v28.i17.1845.
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.
To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these outcomes.
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.
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, = 0.048] and piecemeal resection (OR = 6.610, = 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, = 0.007). Twenty-six patients experienced adverse events (24.5%).
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.
壶腹腺瘤是一种罕见的癌前病变，但发病率正在上升。由于内镜乳头切开术的安全性和有效性，它已成为壶腹腺瘤的首选治疗方法，从而取代了手术切除。然而，内镜乳头切开术后的复发率和不良事件在多达 30%的病例中报告。
回顾内镜乳头切开术的长期结果，并探讨影响这些结果的因素。
我们回顾性分析了 2013 年至 2020 年期间在五家三级医院接受内镜乳头切开术治疗壶腹腺瘤的患者数据。我们评估了临床结果及其危险因素。结果的定义如下：（1）治愈性切除：无复发的完全内镜切除；（2）内镜成功：内镜治疗无需手术干预；（3）早期复发：第一次内镜监测时再次确认腺瘤；（4）晚期复发：第一次内镜监测后再次确认腺瘤。
共纳入 106 例患者进行分析。在纳入的患者中，81 例（76.4%）行治愈性切除，99 例（93.4%）内镜成功，表明大多数非治愈性切除患者均成功采用内镜治疗。16 例（15.1%）行部分切除，22 例（20.8%）行阳性/不确定切缘，11 例（16.1%）早期复发，13 例（10.4%）晚期复发，6 例（5.7%）再复发。多因素分析显示，阳性/不确定切缘（比值比[OR] = 4.023， = 0.048）和部分切除（OR = 6.610， = 0.005）是早期和晚期复发的显著危险因素。部分切除也是非治愈性切除的显著危险因素（OR = 5.424， = 0.007）。26 例患者发生不良事件（24.5%）。
内镜乳头切开术是一种安全有效的治疗壶腹腺瘤的方法。必须仔细选择和随访患者，特别是在阳性/不确定切缘和部分切除的情况下。
