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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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Einführung zu diesem Artikel:

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



Publikationsverlauf

Eingereicht: 19. Mai 2022

Angenommen nach Revision: 06. Februar 2023

Accepted Manuscript online:
06. Februar 2023

Artikel online veröffentlicht:
19. April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Leserbrief zu diesem Artikel:

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

 

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