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. 2024 Feb;38(2):688-696.
doi: 10.1007/s00464-023-10567-z. Epub 2023 Nov 28.

The timing of recurrence after endoscopic papillectomy

Samuel Han #  1 , Joshua A Turkeltaub #  2 , Daniel Jonas  3 , Augustin R Attwell  4 , Anna M Duloy  4 , Steven A Edmundowicz  4 , Hazem T Hammad  4 , Mihir S Wagh  4 , Sachin Wani  4 , Raj J Shah  5   6
Affiliations

The timing of recurrence after endoscopic papillectomy

Samuel Han et al. Surg Endosc. 2024 Feb.

Abstract

Background: 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.

Methods: 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.

Results: 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)].

Conclusion: 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.

Keywords: Ampullary adenocarcinoma; Ampullary adenoma; Ampullectomy; Papillectomy; Recurrence.

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