Reply to Wang et al.

We thank Wang et al. for their thoughtful comments and thorough reading of our manuscript analyzing endoscopic papillectomy for patients with familial adenomatous polyposis (FAP) compared with those with sporadic lesions [11]. We agree that the initial reduced R0 rate was lower in the FAP group, although we thoroughly matched for age, sex, size, histology, and other predictors of treatment success. This may be a result of the different etiology of the lesion but is in line with other observations. Indeed, we did not have information regarding the presence of juxtapapillary diverticula but we assume that this finding is not common enough to have influenced our results. Nevertheless, if additional endoscopic papillectomy was included for R1-treated patients, the final technical success was comparable between FAP and sporadic lesions.

We do not necessarily agree with the fundamental critique that our work was not suitable for such analysis. We examined specific performance measurements of endoscopic papillectomy in detail (submucosal injection, stenting, additional interventions, ablations, pathology, technical and clinical success, and others) and present all these data in the supplementary material. Thus, as we know that more than 50 centers participated in this work, we critically aimed to harmonize the results. Our data are the largest series published to date for endoscopic papillectomy in patients with FAP, and the first to compare and match patients with those with sporadic lesions. In addition, radiofrequency ablation and argon plasma coagulation were only considered for repeated interventions, not for the initial endoscopic papillectomy. This was highlighted in the manuscript several times. There was a clear definition for R0 of endoscopic papillectomy (histologically) or ablation (endoscopy). Regarding recurrences, we could only analyze recurrences in R0-treated patients because otherwise it is considered incomplete resection or remnant disease rather than recurrence. This important difference is often not differentiated but was clearly considered and defined in our work. We thank the authors again for their interest in our manuscript and hope we have clarified their concerns with our study.

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 DOI: 10.1055/a-2029-2935.