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Tytuł:
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Endoscopic papillectomy; a retrospective international multicenter cohort study with long-term follow-up.
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Autorzy:
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Fritzsche JA; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Klein A; Department of Gastroenterology and Hepatology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Beekman MJ; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
van Hooft JE; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Sidhu M; Department of Gastroenterology and Hepatology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Schoeman S; Department of Gastroenterology and Hepatology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Fockens P; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Bourke MJ; Department of Gastroenterology and Hepatology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Voermans RP; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. .
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Źródło:
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Surgical endoscopy [Surg Endosc] 2021 Nov; Vol. 35 (11), pp. 6259-6267. Date of Electronic Publication: 2020 Nov 06.
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Typ publikacji:
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Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
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MeSH Terms:
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Adenoma*
Ampulla of Vater*
Common Bile Duct Neoplasms*
Aged ; Follow-Up Studies ; Humans ; Male ; Neoplasm Recurrence, Local/epidemiology ; Retrospective Studies ; Treatment Outcome
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References:
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Contributed Indexing:
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Keywords: Endoscopic papillectomy; Long-term follow-up; Papillary adenoma; Recurrence
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Entry Date(s):
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Date Created: 20201107 Date Completed: 20211025 Latest Revision: 20220218
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Update Code:
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20240105
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PubMed Central ID:
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PMC8523407
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DOI:
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10.1007/s00464-020-08126-x
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PMID:
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33159297
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Background: Endoscopic papillectomy (EP) is considered a relatively safe and minimally invasive treatment for papillary adenomas. In the literature a significant risk for local recurrence is described. The aim of this study was to evaluate long-term recurrence rates and time-to-recurrence. Additionally, risk factors for recurrence, malignancy and adverse events were studied.
Methods: This is a retrospective study in consecutive patients with papillary adenomas who underwent EP in two tertiary referral hospitals between 2001 and 2018. Primary outcome was recurrence in patients with at least 1-year endoscopic follow-up. Secondary outcomes were surgery free survival, adverse events, and mortality within 30 days after the index procedure.
Results: A total of 259 patients were found eligible [median age 66 years, 130 male (50.2%)]. Forty-three patients were known with familial adenomatous polyposis (FAP) (16.6%). At least 1-year endoscopic follow-up was available in 154 patients with a total follow-up of 586 person-years and median of 40 months [interquartile range (IQR) 25-75]. Recurrence occurred in 24 cases (15.6%) of which 8 were known with FAP, leading to a recurrence incidence rate of 4.1 per 100 person-years with a median time-to-recurrence of 29 months (IQR 14.75-59.5). Fifty-three patients underwent at least 5-year follow-up, in 6 (11.3%) of them recurrence was encountered after 5 years of which four were known with FAP. No risk factors for recurrence could be identified. Adverse events occurred in 50/259 patients (19.3%). One patient died within 30 days after the procedure. Papillary stenosis occurred in 19/259 (7.3%) of the patients. There were no cases of malignant degeneration during follow-up.
Conclusions: Recurrence after EP occurs in a significant proportion of patients and occurs even 5 years after EP. This emphasizes the need for long-term follow-up. We advise to consider at least 5-year follow-up in case of a sporadic adenoma, unless comorbidity makes follow-up clinically irrelevant.
(© 2020. The Author(s).)
