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Endoscopy 2023; 55(08): 709-718
DOI: 10.1055/a-2029-2935
Original article

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

Kien Vu Trung
1   Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
,
Einas Abou-Ali
2   Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
,
Fabrice Caillol 
3   Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
,
Woo H. Paik 
4   Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
,
Bertrand Napoleon
5   Hopital prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France
,
Viliam Masaryk
6   Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
,
Sophia E. van der Wiel 
7   Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
,
Enrique Pérez-Cuadrado-Robles 
8   Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France
 9   Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
,
Nicolas Musquer
10   Clinique Santé Atlantique, Saint Herblain, France
,
Asif Halimi
11   Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
12   Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden
,
Kevin Soares
13   Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
,
Francois R. Souche
14   Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
,
Steffen Seyfried
15   Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
16   Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Maria C. Petrone
17   Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
,
Stefano Crippa
18   Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
,
Tobias Kleemann
19   Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
,
David Albers
20   Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany
,
Tobias J. Weismüller
21   Department of Internal Medicine – Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
22   Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
,
Ana Dugic
11   Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
23   Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
,
Benjamin Meier
24   Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany
,
Edris Wedi
25   Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
26   Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
,
Moritz Schiemer
27   Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
,
Sara Regner
28   Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden
,
Sebastien Gaujoux
29   Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France
,
Marcus Hollenbach 
1   Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
,
ESAP Study Group
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Author commentary on Kien Vu Trung et al.Endoscopy 2023; 55(08): v22-v22
DOI: 10.1055/a-2076-9934

Abstract

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 FAP-related 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.

Tables 1 s, 2 s



Publication History

Received: 19 May 2022

Accepted after revision: 06 February 2023

Accepted Manuscript online:
06 February 2023

Article published online:
19 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Comments on “Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort”Endoscopy 2024; 56(01): 82-83
DOI: 10.1055/a-2182-6101

 

  • References

  • 1 Jemal A, Siegel R, Ward E. et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96
    CrossrefPubMedSearch in Google Scholar
  • 2 Ramai D, Ofosu A, Singh J. et al. Demographics, tumor characteristics, treatment, and clinical outcomes of patients with ampullary cancer: a Surveillance, Epidemiology, and End Results (SEER) cohort study. Minerva Gastroenterol Dietol 2019; 65: 85-90
    CrossrefPubMedSearch in Google Scholar
  • 3 Grobmyer SR, Stasik CN, Draganov P. et al. Contemporary results with ampullectomy for 29 “benign” neoplasms of the ampulla. J Am Coll Surg 2008; 206: 466-471
    CrossrefPubMedSearch in Google Scholar
  • 4 Powell SM, Petersen GM, Krush AJ. et al. Molecular diagnosis of familial adenomatous polyposis. N Engl J Med 1993; 329: 1982-1987
    CrossrefPubMedSearch in Google Scholar
  • 5 Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004; 11: 301-309
    CrossrefPubMedSearch in Google Scholar
  • 6 Kashiwagi H, Spigelman AD, Debinski HS. et al. Surveillance of ampullary adenomas in familial adenomatous polyposis. Lancet 1994; 344: 1582
    CrossrefPubMedSearch in Google Scholar
  • 7 Espinel J, Pinedo E, Ojeda V. et al. Endoscopic management of adenomatous ampullary lesions. World J Methodol 2015; 5: 127-135
    CrossrefPubMedSearch in Google Scholar
  • 8 Kahn MB, Rush Jr. BF. The overlooked technique of ampullary excision. Surg Gynecol Obstet 1989; 169: 253-254
    PubMedSearch in Google Scholar
  • 9 Talamini MA, Moesinger RC, Pitt HA. et al. Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 1997; 225: 590-599 discussion 599-600
    CrossrefPubMedSearch in Google Scholar
  • 10 Lee H, Park JY, Kwon W. et al. Transduodenal ampullectomy for the treatment of early-stage ampulla of Vater cancer. World J Surg 2016; 40: 967-973
    CrossrefPubMedSearch in Google Scholar
  • 11 van Heumen BW, Nieuwenhuis MH, van Goor H. et al. Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: a nationwide retrospective cohort study. Surgery 2012; 151: 681-690
    CrossrefPubMedSearch in Google Scholar
  • 12 Lepistö A, Kiviluoto T, Halttunen J. et al. Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis. Endoscopy 2009; 41: 504-509
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Hong S, Song KB, Lee YJ. et al. Transduodenal ampullectomy for ampullary tumors – single center experience of consecutive 26 patients. Ann Surg Treat Res 2018; 95: 22-28
    CrossrefPubMedSearch in Google Scholar
  • 14 De Palma GD. Endoscopic papillectomy: indications, techniques, and results. World J Gastroenterol 2014; 20: 1537-1543
    CrossrefPubMedSearch in Google Scholar
  • 15 Heise C, Abou AliE, Hasenclever D. et al. Systematic review with meta-analysis: endoscopic and surgical resection for ampullary lesions. J Clin Med 2020; 9: 3622
    CrossrefPubMedSearch in Google Scholar
  • 16 Vanbiervliet G, Strijker M, Arvanitakis M. et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 429-448
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Itoi T, Ryozawa S, Katanuma A. et al. Clinical practice guidelines for endoscopic papillectomy. Dig Endosc 2022; 34: 394-411
    CrossrefPubMedSearch in Google Scholar
  • 18 Gluck N, Strul H, Rozner G. et al. Endoscopy and EUS are key for effective surveillance and management of duodenal adenomas in familial adenomatous polyposis. Gastrointest Endosc 2015; 81: 960-966
    CrossrefPubMedSearch in Google Scholar
  • 19 Ouaïssi M, Panis Y, Sielezneff I. et al. Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis. Dis Colon Rectum 2005; 48: 2192-2196
    CrossrefPubMedSearch in Google Scholar
  • 20 Ma T, Jang EJ, Zukerberg LR. et al. Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome. Surg Endosc 2014; 28: 2349-2356
    CrossrefPubMedSearch in Google Scholar
  • 21 Roos VH, Bastiaansen BA, Kallenberg FGJ. et al. Endoscopic management of duodenal adenomas in patients with familial adenomatous polyposis. Gastrointest Endosc 2021; 93: 457-466
    CrossrefPubMedSearch in Google Scholar
  • 22 Cecinato P, Parmeggiani F, Braglia L. et al. Endoscopic papillectomy for ampullary adenomas: different outcomes in sporadic tumors and those associated with familial adenomatous polyposis. J Gastrointest Surg 2021; 25: 457-466
    CrossrefPubMedSearch in Google Scholar
  • 23 Catalano MF, Linder JD, Chak A. et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59: 225-232
    CrossrefPubMedSearch in Google Scholar
  • 24 Hollenbach M, Ali EA, Auriemma F. et al. Study protocol of the ESAP study: endoscopic papillectomy vs. surgical ampullectomy vs. pancreaticoduodenectomy for ampullary neoplasm – a Pancreas2000/EPC Study. Front Med 2020; 7: 152
    CrossrefPubMedSearch in Google Scholar
  • 25 Vandenbroucke JP, von Elm E, Altman DG. et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297
    CrossrefPubMedSearch in Google Scholar
  • 26 Tsuji S, Itoi T, Sofuni A. et al. Tips and tricks in endoscopic papillectomy of ampullary tumors: single-center experience with large case series (with videos). J Hepatobiliary Pancreat Sci 2015; 22: E22-27
    CrossrefPubMedSearch in Google Scholar
  • 27 Patel R, Varadarajulu S, Wilcox CM. Endoscopic ampullectomy: techniques and outcomes. J Clin Gastroenterol 2012; 46: 8-15
    CrossrefPubMedSearch in Google Scholar
  • 28 Ben-Menachem T, Decker GA, Early DS. et al. Adverse events of upper GI endoscopy. Gastrointest Endosc 2012; 76: 707-718
    Search in Google Scholar
  • 29 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    Search in Google Scholar
  • 30 Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28: 3083-3107
    CrossrefPubMedSearch in Google Scholar
  • 31 Chung KH, Lee SH, Choi JH. et al. Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: propensity-score matching analysis. United European Gastroenterol J 2018; 6: 576-585
    CrossrefPubMedSearch in Google Scholar
  • 32 Hyun JJ, Lee TH, Park JS. et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc 2017; 85: 746-755
    CrossrefPubMedSearch in Google Scholar
  • 33 Okano N, Igarashi Y, Ito K. et al. Efficacy of hypertonic saline-epinephrine local injection around the anal side before endoscopic papillectomy for ampullary tumors. Clin Endosc 2021; 54: 706-712
    CrossrefPubMedSearch in Google Scholar
  • 34 van Wanrooij RLJ, van Hooft JE. Submucosal epinephrine injection before endoscopic papillectomy: less is more?. Clin Endosc 2021; 54: 627-628
    CrossrefPubMedSearch in Google Scholar
  • 35 Ramai D, Facciorusso A, Singh J. et al. Endoscopic management of ampullary adenomas in familial adenomatous polyposis syndrome: a systematic review with pooled analysis. Dig Dis Sci 2022; 67: 3220-3227
    CrossrefPubMedSearch in Google Scholar
  • 36 Li S, Wang Z, Cai F. et al. New experience of endoscopic papillectomy for ampullary neoplasms. Surg Endosc 2019; 33: 612-619
    CrossrefPubMedSearch in Google Scholar
  • 37 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Ridtitid W, Tan D, Schmidt SE. et al. Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc 2014; 79: 289-296
    CrossrefPubMedSearch in Google Scholar
  • 39 Yang J, Gurudu SR, Koptiuch C. et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc 2020; 91: 963-982
    CrossrefPubMedSearch in Google Scholar
  • 40 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
    CrossrefPubMedSearch in Google Scholar