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

Kien Vu Trung; Einas Abou-Ali; Fabrice Caillol; Woo H. Paik; Bertrand Napoleon; Viliam Masaryk; Sophia E. van der Wiel; Enrique Pérez-Cuadrado-Robles; Nicolas Musquer; Asif Halimi; Kevin Soares; Francois R. Souche; Steffen Seyfried; Maria C. Petrone; Stefano Crippa; Tobias Kleemann; David Albers; Tobias J. Weismüller; Ana Dugic; Benjamin Meier; Edris Wedi; Moritz Schiemer; Sara Regner; Sebastien Gaujoux; Marcus Hollenbach; ESAP Study Group

doi:10.1055/a-2029-2935

Endoscopy, Inhaltsverzeichnis

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

¹Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany

,

Einas Abou-Ali

²Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France

,

Fabrice Caillol

³Department of Endoscopy, Institut Paoli Calmettes, Marseille, France

,

Woo H. Paik

⁴Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

,

Bertrand Napoleon

⁵Hopital prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France

,

Viliam Masaryk

⁶Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany

,

Sophia E. van der Wiel

⁷Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands

,

Enrique Pérez-Cuadrado-Robles

⁸Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France

⁹Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium

,

Nicolas Musquer

¹⁰Clinique Santé Atlantique, Saint Herblain, France

,

Asif Halimi

¹¹Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

¹²Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden

,

Kevin Soares

¹³Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

Francois R. Souche

¹⁴Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France

,

Steffen Seyfried

¹⁵Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany

¹⁶Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany

,

Maria C. Petrone

¹⁷Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy

,

Stefano Crippa

¹⁸Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy

,

Tobias Kleemann

¹⁹Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

,

David Albers

²⁰Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany

,

Tobias J. Weismüller

²¹Department of Internal Medicine – Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany

²²Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

,

Ana Dugic

¹¹Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

²³Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany

,

Benjamin Meier

²⁴Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany

,

Edris Wedi

²⁵Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany

²⁶Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany

,

Moritz Schiemer

²⁷Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany

,

Sara Regner

²⁸Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden

,

Sebastien Gaujoux

²⁹Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France

,

Marcus Hollenbach

¹Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany

,

ESAP Study Group

(

Francesco Auriemma

³⁰Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano Milano, Italy

,

Aiste Gulla

³¹Department of Surgery, Vilnius University Hospital “Santaros klinikos”, Vilnius, Lithuania

³²Department of Surgery, MedStar Georgetown University Hospital, Georgetown, Washington, D.C., United States

,

Elias Karam

³³Visceral Surgery Unit, Centre Hospitalier Universitaire de Tours, Tours, France

,

Marc Giovannini

³Department of Endoscopy, Institut Paoli Calmettes, Marseille, France

,

Jean-Philippe Ratone

³Department of Endoscopy, Institut Paoli Calmettes, Marseille, France

,

Uwe Will

⁶Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany

,

Rita Saadeh

⁶Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany

,

Marco J. Bruno

⁷Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands

,

Pierre Deprez

⁹Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium

,

Urban Arnelo

¹¹Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

¹²Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden

,

Erik Haraldsson

¹¹Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

³⁴Department of Surgery, Skaraborg Hospital, Skövde, Sweden

,

Alexander Waldthaler

³⁵Department of Upper Abdominal Diseases at Karolinska University Hospital, Stockholm, Sweden

³⁶Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden

,

Galen Leung

³⁷Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States

,

Mark A. Schattner

³⁸Gastroenterology Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

William R. Jarnagin

¹³Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

Tiegong Wang

¹³Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States

,

Jean M. Fabre

¹⁴Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France

,

Georg Kähler

¹⁵Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany

¹⁶Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany

,

Alberto Mariani

³⁹Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Piera Zaccari

³⁹Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy

⁴⁰Department of Translational and Precision Medicine, Sapienza University, Rome, Italy

,

Giulio Belfiori

¹⁸Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy

,

Massimo Falconi

¹⁸Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy

,

Stefano Partelli

¹⁸Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy

,

Alessandro Repici

³⁰Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano Milano, Italy

,

Andrea Anderloni

³⁰Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano Milano, Italy

,

Johanna Laukkarinen

⁴¹Tampere University Hospital, Tampere, Finland

⁴²Faculty of Medicine and Health Technology, Medical School, Tampere University, Tampere, Finland

,

Albrecht Hoffmeister

¹Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany

,

Jonas Rosendahl

⁴³Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany

,

Brigitte Schumacher

²⁰Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany

,

Louise Barbier

⁴⁴Department of Digestive Surgery, Centre hospitalo-universitaire de Tours, Tours, France

,

Dominik Heling

²²Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

,

Steffen Muehldorfer

²³Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany

,

Stéphanie Truant

⁴⁵Department of Digestive Surgery, Centre hospitalo-universitaire de Lille, Lille, France

,

Karel Caca

²⁴Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany

,

Marcel Tantau

⁴⁶Regional Institute of Gastroenterology and Hepatology “Octavian Fodor,” Hepatology Department and “Iuliu Hatieganu” University of Medicine and Pharmacy, 3rd Medical Clinic, Cluj-Napoca, Romania

,

Katrin Salzmann

²⁵Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany

,

Patrice David

⁴⁷Department of Digestive Surgery, Hopital Louis Pasteur, Colmar, France

,

Arthur Schmidt

²⁷Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany

,

Tullio Piardi

⁴⁸Department of Digestive Surgery, Centre Hospitalier Universitaire de Reims, Reims, France

,

J. Matthias Löhr

¹¹Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

¹⁹Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

,

Johan Gagniére

⁴⁹Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France

⁵⁰U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France

,

Bogdan P. Miutescu

⁵¹Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania

,

Arthur Berger

⁵²Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Angers, Angers, France

,

Peter Schemmer

⁵³Department of General, Visceral and Transplantation Surgery, Medical University of Graz, Graz, Austria

,

Christian Heise

⁴³Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany

,

Vasile Sandru

⁵⁴Department of Gastroenterology and Interventional Endoscopy, Clinical Emergency Hospital, Bucharest, Romania

⁵⁵“Carol Davila” University of Pharmacy and Medicine, Bucharest, Romani

,

Reea Ahola

⁴¹Tampere University Hospital, Tampere, Finland

,

Mario Dinis-Ribeiro

⁵⁶Department of Gastroenterology, Instituto Português de Oncologia do, Porto, Portugal

⁵⁷RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal

⁵⁸Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal

,

Tiago Cúrdia Gonçalves

⁵⁹Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal

⁶⁰School of Medicine, University of Minho, Braga/Guimarães, Portugal

⁶¹ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal

,

Dörte Wichmann

⁶²Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany

)› Institutsangaben

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.

Volltext

Referenzen

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