Endoscopic papillectomy: Risk factors for incomplete resection and recurrence during long-term follow-up

Wiriyaporn Ridtitid, Damien Tan, Suzette E. Schmidt, Evan Fogel, Lee McHenry, James L. Watkins, Glen Lehman, Stuart Sherman, Gregory A. Coté

Research output: Contribution to journalArticle

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Abstract

Background Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. Objective To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patients All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. Intervention Endoscopic papillectomy. Main Outcome Measurements Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. Results We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P =.009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P =.002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P =.011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P =.001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. Limitations Retrospective analysis. Conclusion Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.

Original languageEnglish
Pages (from-to)289-296
Number of pages8
JournalGastrointestinal Endoscopy
Volume79
Issue number2
DOIs
StatePublished - Feb 2014

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Recurrence
Adenoma
Odds Ratio
Confidence Intervals
Jaundice
Adenocarcinoma
Tertiary Healthcare
Survival Analysis
Cohort Studies
Retrospective Studies
Safety

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Endoscopic papillectomy : Risk factors for incomplete resection and recurrence during long-term follow-up. / Ridtitid, Wiriyaporn; Tan, Damien; Schmidt, Suzette E.; Fogel, Evan; McHenry, Lee; Watkins, James L.; Lehman, Glen; Sherman, Stuart; Coté, Gregory A.

In: Gastrointestinal Endoscopy, Vol. 79, No. 2, 02.2014, p. 289-296.

Research output: Contribution to journalArticle

Ridtitid, Wiriyaporn ; Tan, Damien ; Schmidt, Suzette E. ; Fogel, Evan ; McHenry, Lee ; Watkins, James L. ; Lehman, Glen ; Sherman, Stuart ; Coté, Gregory A. / Endoscopic papillectomy : Risk factors for incomplete resection and recurrence during long-term follow-up. In: Gastrointestinal Endoscopy. 2014 ; Vol. 79, No. 2. pp. 289-296.
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abstract = "Background Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. Objective To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patients All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. Intervention Endoscopic papillectomy. Main Outcome Measurements Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. Results We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6{\%}) having complete resection. Short-term adverse events occurred in 34 (18.7{\%}). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95{\%} confidence interval [CI] 0.07-0.69; P =.009), occult adenocarcinoma (OR 0.06; 95{\%} CI, 0.01-0.36; P =.002), and intraductal involvement (OR 0.29; 95{\%} CI, 0.11-0.75; P =.011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95{\%} CI, 1.71-9.59; P =.001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15{\%}) developed recurrence up to 65 months after resection. Limitations Retrospective analysis. Conclusion Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.",
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T2 - Risk factors for incomplete resection and recurrence during long-term follow-up

AU - Ridtitid, Wiriyaporn

AU - Tan, Damien

AU - Schmidt, Suzette E.

AU - Fogel, Evan

AU - McHenry, Lee

AU - Watkins, James L.

AU - Lehman, Glen

AU - Sherman, Stuart

AU - Coté, Gregory A.

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N2 - Background Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. Objective To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patients All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. Intervention Endoscopic papillectomy. Main Outcome Measurements Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. Results We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P =.009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P =.002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P =.011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P =.001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. Limitations Retrospective analysis. Conclusion Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.

AB - Background Endoscopic papillectomy is increasingly used as an alternative to surgery for ampullary adenomas and other noninvasive ampullary lesions. Objective To measure short-term safety and efficacy of endoscopic papillectomy, define patient and lesion characteristics associated with incomplete endoscopic resection, and measure adenoma recurrence rates during long-term follow-up. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patients All patients who underwent endoscopic papillectomy for ampullary lesions between July 1995 and June 2012. Intervention Endoscopic papillectomy. Main Outcome Measurements Patient and lesion characteristics associated with incomplete endoscopic resection and ampullary adenoma-free survival analysis. Results We identified 182 patients who underwent endoscopic papillectomy, 134 (73.6%) having complete resection. Short-term adverse events occurred in 34 (18.7%). Risk factors for incomplete resection were jaundice at presentation (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.07-0.69; P =.009), occult adenocarcinoma (OR 0.06; 95% CI, 0.01-0.36; P =.002), and intraductal involvement (OR 0.29; 95% CI, 0.11-0.75; P =.011). The en bloc resection technique was strongly associated with a higher rate of complete resection (OR 4.05; 95% CI, 1.71-9.59; P =.001). Among patients with ampullary adenoma who had complete resection (n = 107), 16 patients (15%) developed recurrence up to 65 months after resection. Limitations Retrospective analysis. Conclusion Jaundice at presentation, occult adenocarcinoma in the resected specimen, and intraductal involvement are associated with a lower rate of complete resection, whereas en bloc papillectomy increases the odds of complete endoscopic resection. Despite complete resection, recurrence was observed up to 5 years after papillectomy, confirming the need for long-term surveillance.

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