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

Vu Trung K, Abou-Ali E, Caillol F, Paik WH, Napoleon B, Masaryk V, van der Wiel SE, Pérez-Cuadrado-Robles E, Musquer N, Halimi A, Soares K, Souche FR, Seyfried S, Petrone MC, Crippa S, Kleemann T, Albers D, Weismüller TJ, Dugic A, Meier B, Wedi E, Schiemer M, Regner S, Gaujoux S, Hollenbach M (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 55

Pages Range: 709-718

Journal Issue: 8

DOI: 10.1055/a-2029-2935

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.

Authors with CRIS profile

Involved external institutions

Institute Paoli-Calmettes France (FR) Hôpital Privé Jean Mermoz France (FR) Erasmus University Medical Center (MC) Netherlands (NL) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Carl-Thiem-Klinikum Germany (DE) Karolinska Institute Sweden (SE) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Universität Leipzig Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH Germany (DE) Lund University / Lunds universitet Sweden (SE) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Institut de Cancérologie de l'Ouest France (FR) Albert-Ludwigs-Universität Freiburg Germany (DE) Memorial Sloan Kettering Cancer Center United States (USA) (US) Centre Hospitalier Universitaire de Montpellier (CHU/CHRU MTP) France (FR) Ruprecht-Karls-Universität Heidelberg Germany (DE) Regionale Kliniken Holding RKH Germany (DE) Universitätsklinikum Göttingen Germany (DE) SRH Wald-Klinikum Gera Germany (DE) Hôpital Cochin France (FR) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR)

How to cite

APA:

Vu Trung, K., Abou-Ali, E., Caillol, F., Paik, W.H., Napoleon, B., Masaryk, V.,... Hollenbach, M. (2023). Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort. Endoscopy, 55(8), 709-718. https://dx.doi.org/10.1055/a-2029-2935

MLA:

Vu Trung, Kien, et al. "Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort." Endoscopy 55.8 (2023): 709-718.

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