Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: A propensity score-matched cohort

• 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 FAPrelated 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. © 2022 Georg Thieme Verlag. All rights reserved.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

Adenomatous Polyposis Coli

Ampulla of Vater

Common Bile Duct Neoplasms

Humans

Neoplasm Recurrence, Local

Propensity Score

Retrospective Studies

Treatment Outcome

ablation therapy

adult

adverse event

aged

American Society of Anaesthesiologists score

ampullectomy

Article

bile duct dilatation

cardiovascular disease

cholangitis

clinical feature

clinical outcome

cohort analysis

comorbidity

conscious sedation

controlled study

disease free survival

duodenum injury

en bloc resection

endoscopic papillotomy

endoscopic retrograde cholangiopancreatography

endoscopic surgery

familial adenomatous polyposis

female

follow up

general anesthesia

histology

human

human tissue

laboratory test

length of stay

lifetime risk

major clinical study

male

overall survival

pancreaticoduodenectomy

pancreatitis

perforation

postoperative complication

postoperative hemorrhage

propensity score

radiofrequency ablation

recurrent disease

retrospective study

sporadic ampullary lesion

Vater papilla tumor

ampulla of Vater

bile duct tumor

clinical trial

colon polyposis

multicenter study

pathology

treatment outcome

tumor recurrence

Publikations- och innehållstyp

art (ämneskategori)

ref (ämneskategori)