ENDOSCOPIC PAPILLECTOMY IN A LARGE MULTICENTER OBSERVATIONAL STUDY: STILL WAY FOR IMPROVEMENT

Aims Endoscopic papillectomy (EP) is reported to be a relative safe and efficient treatment for selective tumors of the ampulla of Vater, with lower morbidity and mortality rates than surgery. However, large-scale studies are limited. The aim of this study was to evaluate the efficacy and safety of EP and to determine risk factors for recurrence and complications.

Methods This is a retrospective multicenter observational study. All patients who underwent EP in 5 tertiary referral centers between January 2008 and December 2018 were included. Morphological and histological characteristics of lesions, modalities of ampullectomy, complications and endoscopic follow-up were collected. Risk factors for recurrence were analyzed using univariate and multivariable Cox regression with 95% confidence intervals.

Results 227 patients were included (sex ratio 1.5, mean age 61 years). The tumor mean size was 20 mm. 2.9 % of lesions had duodenal extension and 15.5% intraductal invasion. There was 48% of tumor with low grade dysplasia (n = 108), 33.3% with high grade dysplasia (n = 75) and 10.7% with invasive adenocarcinoma (n = 24). The resection was en bloc in 65.2% cases, classified R0 in 57.3% cases. The recurrence rate was 30.9 % (n=64) with a median time to recurrence of 6.4 months. 60.9 % of recurrences were treated efficiently by additional endoscopic treatment. Finally, 84.5% (n = 175) of patients were cured with a median time to follow up of 22 months. In multivariable analysis, incomplete resection (OR: 2.64, CI: 1.31-5.31, p = 0.006) and tumor size (OR: 1.04, CI: 1.01-1.07, p = 0.017) were correlated with endoscopic recurrence. Complications included bleeding (26 %), pancreatitis (17.6%), perforation (5.2%) and biliary stenosis (2.6%). The mortality was 0.9%.

Conclusions EP is an effective and relatively safe curative treatment for localized ampullomas. R1 resection and lesion size are correlated with endoscopic recurrence.