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The timing of recurrence after endoscopic papillectomy

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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.

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Acknowledgements

This article is dedicated to the memory of Dr. Brian C. Brauer (1973-2019), MD, whose presence lives on in our efforts to mentor trainees, perform research, and advance the art of endoscopic practice.

Funding

NIH T32DK007038 (SH).

Author information

Author notes

  1. Samuel Han and Joshua A. Turkeltaub share co-first authorship.

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Samuel Han

  2. Division of Digestive Health and Liver Disease, University of Miami Miller School of Medicine, Miami, FL, USA

    Joshua A. Turkeltaub

  3. Division of Gastroenterology and Nutrition, Loyola University Medicine, Chicago, IL, USA

    Daniel Jonas

  4. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Augustin R. Attwell, Anna M. Duloy, Steven A. Edmundowicz, Hazem T. Hammad, Mihir S. Wagh, Sachin Wani & Raj J. Shah

  5. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, 1635 Aurora Ct, Mail Stop F735, Rm. AIP 2.031, Aurora, CO, 80045, USA

    Raj J. Shah

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Correspondence to Raj J. Shah.

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Disclosures

Dr. Raj Shah is an advisory board member and consultant for Boston Scientific and a consultant for Olympus and Cook Medical. Dr. Sachin Wani is an advisory board member for Cernostics, a consultant for Exact Sciences and Interpace, and has received research funding from Lucid, Ambu, and CDx. Dr. Steven Edmundowicz is an advisory board member for Olympus. Dr. Mihir Wagh is a consultant for Boston Scientific and Medtronic. Dr. Hazem Hammad is a consultant for Medtronic, Olympus, and Cook Medical. Dr. Samuel Han, Dr. Joshua Turkeltaub, Dr. Daniel Jonas, Dr. Augustin Attwell, and Dr. Anna Duloy have no conflicts of interest to disclose.

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Results of this paper were presented as an oral presentation at Digestive Disease Week.

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Supplementary file1 (DOCX 13 KB)

464_2023_10567_MOESM2_ESM.tif

Supplementary Figure 1: Serial endoscopic images of subject with early recurrence starting with A) initial ampullary adenoma, B) index papillectomy, C) surveillance exam after eradication achieved, and D) recurrence of lesion at 6-month post-eradication

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Han, S., Turkeltaub, J.A., Jonas, D. et al. The timing of recurrence after endoscopic papillectomy. Surg Endosc 38, 688–696 (2024). https://doi.org/10.1007/s00464-023-10567-z

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