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Long-term recurrence after endoscopic versus surgical ampullectomy of sporadic ampullary adenomas: a systematic review and meta-analysis

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Abstract

Background and aims

Ampullary adenomas are treated both surgically and endoscopically, however, data comparing both techniques are lacking. We aimed to compare long-term recurrence of benign sporadic adenomas after endoscopic (EA) and surgical ampullectomy (SA).

Methods

A comprehensive literature search of multiple databases (until December 29, 2020) was performed to identify studies reporting outcomes of EA or SA of benign sporadic ampullary adenomas. The outcome was recurrence rate at 1 year, 2-year, 3 year and 5 years after EA and SA.

Results

A total of 39 studies with 1753 patients (1468 EA [age 61.1 ± 4.0 years, size 16.1 ± 4.0 mm], 285 SA [mean age 61.6 ± 4.48 years, size 22.7 ± 5.4 mm]) were included in the analysis. At year 1, pooled recurrence rate of EA was 13.0% (95% confidence interval [CI] 10.5—15.9], I2 = 31%) as compared to SA 14.1% (95% CI 9.5—20.3 I2 = 15.8%) (p = 0.82). Two (12.5%, [95% CI, 8.9—17.2] vs. 14.3 [95% CI, 9.1—21.6], p = 0.63), three (13.3%, [95% CI, 7.3—21.6] vs. 12.9 [95% CI, 7.3—21.6], p = 0.94) and 5 years (15.7%, [95% CI, 7.8—29.1] vs. 17.6% [95% CI, 6.2—40.8], p = 0.85) recurrence rate were comparable after EA and SA. On meta-regression, age, size of lesion or enbloc and complete resection were not significant predictors of recurrence.

Conclusion

EA and SA of sporadic adenomas have similar recurrence rates at 1, 2, 3 and 5 years of follow up.

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  1. Rajat Garg and Komal Thind are co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA

    Rajat Garg, C. Roberto Simons-Linares, Amandeep Singh & Prabhleen Chahal

  2. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA

    Komal Thind & Jaideep Bhalla

  3. Cleveland Clinic Alumni Library, Cleveland Clinic, Cleveland, OH, USA

    Marian T. Simonson

  4. Department of Hepatopancreaticobiliary Surgery, Digestive Diseases and Surgery Institute Cleveland Clinic, Cleveland, OH, USA

    Daniel Joyce

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Contributions

Conception and design, drafting of article—KT, RG, ADS, PC. Study search, review, and selection—KT, JB. Data collection and synthesis—KT, JB. Statistical analysis of data and interpretation of results—RG. All authors: critical revision of the article for important intellectual content and final approval of the article.

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Drs. Rajat Garg, Komal Thind, Jaideep Bhalla, Marian Simonson, C. Roberto Simons-Linares, Amandeep Singh, Daniel Joyce and Prabhleen Chahal have no conflicts of interest and nothing to disclose.

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Garg, R., Thind, K., Bhalla, J. et al. Long-term recurrence after endoscopic versus surgical ampullectomy of sporadic ampullary adenomas: a systematic review and meta-analysis. Surg Endosc 37, 5022–5044 (2023). https://doi.org/10.1007/s00464-023-10083-0

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