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

We read with great interest the article by Vu Trung et al. [1] analyzing the efficacy and safety of endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis (FAP) compared with sporadic lesions. We agree that endoscopic papillectomy is useful for the resection of ampullary lesions in patients with FAP; however, we have some questions about the research.

First, patients in FAP and sporadic ampullary lesion groups had ampullary lesions caused by different etiologies. Why was there a significant difference in R0 resection rate between the two groups? Was it related to the lesion morphology, invasive depth, or presence of diverticula [2]? The discussion section of the article speculated that it might be related to different endoscopic resection techniques, rather than the classification of ampullary lesions. Methods of endoscopic resection were not standardized, which would render this research unable to prove that endoscopic papillectomy was effective for FAP-related ampullary lesions through the R0 resection rate.

Second, was it appropriate to consider radiofrequency ablation and argon plasma coagulation as endoscopic remedies when repeat interventions were required? Owing to the fundamental differences from endoscopic excision [3] [4], the success of radiofrequency ablation and argon plasma coagulation does not represent the success of endoscopic papillectomy.

Third, this research only recorded the recurrence rate of patients with R0 resections, but the R0 resection rates between the two groups were already different. Was it meaningful to analyze this result? Would it be more reasonable and necessary to analyze the recurrence rate of all patients?

In summary, even though this research had some limitations, endoscopic papillectomy remained a useful method for ampullary lesions in patients with FAP.

Publication History

Article published online:
21 December 2023

• References

• 1 Vu Trung K, Abou-Ali E, Caillol F. et al. Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort. Endoscopy 2023; 55: 709-718
• 2 Yamamoto K, Iwasaki E, Itoi T. Insights and updates on endoscopic papillectomy. Expert Rev Gastroenterol Hepatol 2020; 14: 435-444 DOI: 10.1080/17474124.2020.1766965. (PMID: 32380873)
• 3 Nam K, Song TJ, Kim RE. et al. Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma. Dig Endosc 2018; 30: 485-492 DOI: 10.1111/den.13008. (PMID: 29288506)
• 4 Valente R, Urban O, Del Chiaro M. et al. ERCP-directed radiofrequency ablation of ampullary adenomas: a knife-sparing alternative in patients unfit for surgery. Endoscopy 2015; 47 (Suppl. 01) E515-516 DOI: 10.1055/s-0034-1392866. (PMID: 26528678)