Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Digestive Health and Liver Disease, University of Miami Miller School of Medicine, Miami, FL, USA.
Surg Endosc. 2024 Feb;38(2):688-696. doi: 10.1007/s00464-023-10567-z. Epub 2023 Nov 28.
Endoscopic papillectomy (EP) offers a safe and effective method for resection of ampullary adenomas. Data regarding the long-term resolution of adenoma following EP are limited. The aim of this study therefore was to examine the timing of recurrence after EP of ampullary adenomas.
This was a single-center retrospective study including patients who received EP for ampullary adenomas from 8/2000 to 1/2018. Patients with confirmed complete eradication of adenoma were included in the recurrence analysis with recurrence defined as finding adenomatous histology after 1 negative surveillance endoscopy. Kaplan-Meier estimates were calculated to determine recurrence rates.
Of the 165 patients who underwent EP, 136 patients (mean age 61.9, 51.5% female) had adenomatous histology with a mean lesion size of 21.2 mm. A total of 124 (91.2%) achieved complete eradication with a follow-up of 345.8 person-years. Recurrence occurred in 20 (16.1%) patients at a mean of 3.2 (± 3) years (range 0.5-9.75 years) for a recurrence rate of 5.8 (95% CI 3.6-8.8) per 100 person-years. Nine (45%) recurrences occurred after the 1st 2 years of surveillance. Recurrence rate did not differ by baseline pathology [low-grade dysplasia: 5.2 (95% CI 3.0-9.0), high-grade dysplasia: 6.9 (95% CI 2.3-15.5), adenocarcinoma: 7.7 (95% CI 0.9-25.1)].
Recurrence remains a significant concern after EP. Given the timing of recurrence, long surveillance periods may be necessary. Larger multicenter studies are needed, however, to determine appropriate surveillance intervals.
内镜乳头括约肌切开术（EP）为切除壶腹腺瘤提供了一种安全有效的方法。关于 EP 后腺瘤长期缓解的数据有限。因此，本研究旨在检查 EP 切除壶腹腺瘤后复发的时间。
这是一项单中心回顾性研究，纳入了 2000 年 8 月至 2018 年 1 月期间因壶腹腺瘤接受 EP 治疗的患者。纳入了腺瘤组织学完全消除的患者进行复发分析，定义为 1 次阴性监测内镜后发现腺瘤组织学。计算 Kaplan-Meier 估计以确定复发率。
在 165 例接受 EP 的患者中，136 例（平均年龄 61.9 岁，51.5%为女性）有腺瘤组织学，平均病变大小为 21.2mm。共有 124 例（91.2%）完全消除，随访时间为 345.8 人年。20 例（16.1%）患者在平均 3.2（±3）年后复发（范围 0.5-9.75 年），复发率为 5.8（95%可信区间 3.6-8.8）/100 人年。9 例（45%）复发发生在监测的前 2 年内。复发率与基线病理学无差异[低级别异型增生：5.2（95%可信区间 3.0-9.0），高级别异型增生：6.9（95%可信区间 2.3-15.5），腺癌：7.7（95%可信区间 0.9-25.1）]。
EP 后复发仍是一个重要问题。鉴于复发的时间，可能需要较长的监测期。然而，需要更大规模的多中心研究来确定适当的监测间隔。
