2934 Thermal Ablation Is Effective for Recurrent Papillary Adenomas After Endoscopic Resection

Abstract

INTRODUCTION: Endoscopic papillectomy (EP) has been regarded as a safe and effective treatment for benign or premalignant ampullary tumors. There were many studies about indications, techniques, short-term and long-term complications, and prognosis. However, 5%-24% of cases of complete resection by EP have been recurred within 6-24 months. Proper treatment for recurrent cases depends on the individual features. Because papilla changed to flat fibrous scar after EP, 2nd EP is usually impossible or induces severe complications. Thermal ablation with electrocautery or argon plasma coagulation, approved as an effective and safe procedure for recurrent papillary adenomas. However, there were few data about long-term effects of thermal ablation for recurred ampullary neoplasm. We retrospectively analyzed the cases of papillary tumors treated by conventional EP and followed for more than 5 years. For recurrent papillary adenomas, we treated with thermal ablation with bipolar electrocautery and followed for more than 3 years. METHODS: Twenty cases with papillary mass who underwent EP over a 10 year were reviewed. Endoscopic papillectomy was performed for benign or premalignant papillary tumors. Surveillance after EP was performed at 3, 9 months and yearly thereafter with side-viewing endoscopy. During follow-up, recurrent cases were treated depending on pathological diagnosis and long-term outcomes were analyzed. Mean duration of follow-up was 52 months. RESULTS: Pathologic diagnosis were low grade dysplasia (n = 11), high grade dysplasia (n = 3), adenomyoma (n = 3), inflammatory lesion (n = 2), and paraganglioma (n = 1). Complete resection achieved in 19 cases by en block in 18 cases (90%) and additional endoscopic thermal ablation in one case with low grade dysplasia. One case of incomplete resection revealed high grade dysplasia and was treated with surgical ampullectomy. Three sporadic cases and one familial colonic polyposis recurred at 16, 18, 24, and 36 months after surgery, respectively. Three low grade dysplasia and one high grade dysplasia diagnosed by papillectomy pathology revealed low grade dysplasia by surveillance biopsy. Four cases were treated with one or multiple sessions of electrocoagulation. During follow up period after 2nd treatment, recurrence did not occurred. CONCLUSION: Recurrence occurred frequently in ampullary adenomas after complete resection. However, they can be safely treated with thermal ablation. Careful surveillance more than 3 years is needed after EP for ampullary adenomas.