Sa1275 ENDOSCOPIC RESECTION OF ADVANCED AMPULLARY ADENOMAS: A SINGLE-CENTER 14 YEAR RETROSPECTIVE COHORT STUDY

Abstract

Adenomas of the ampulla of Vater are rare. Endoscopic ampullectomy has been recognized as a safe and reliable treatment of selective tumors of the ampulla of Vater and is associated with lower morbidity and mortality rates than surgical resection. However, the success rates for endoscopic ampullectomy range from 42-92%, with recurrence described in up to 33%. Despite the increasing number of studies concerning endoscopic resection of ampullary tumors, data evaluating endoscopic resection of the more advanced ampullary adenomas are limited. We aimed to evaluate the technical success, complications and recurrence of endoscopic resection for treating patients with ampullary adenomas with intraductal extension (IEA), or with a lateral spreading growth pattern (LSA). Between January 2002 and November 2016 all patients referred to the Erasmus Medical Center Rotterdam, for endoscopic resection of an ampullary lesion were retrospectively identified. Cases were selected using ENDOBASE and our local PALGA database. We included patients with a histological diagnosis of adenoma. Endoscopic success was defined as complete excision of the adenoma, irrespective of the number of attempts, and in the absence of recurrence. All patients underwent endoscopic follow-up. We included 84 patients, 56 patients (67%) had an adenoma confined to the ampulla (ACA), 17 patients (20%) had an LSA and 11 patients (13%) were treated for adenomas that demonstrated growth pattern with intraductal extension. Fifty-four percent of patients were men and the median age was 67.6 years. The mean lesion size was 24.6mm (range 5-80) for patients with ACA, 34.8mm (range 23-50) for LSA and 16.3mm (range 10-20) for patients with an IEA (P=0.005) Complications occurred in 22 patients (26.2%), of which hemorrhage was most prevalent (11.9%), followed by perforation (8.3%). Complications were equally divided (P=0.528). The mean follow-up duration was 21.1 months (IQR 12-45.9) for ACA, 14.3 months (IQR 3.3-34.1) for LSA and 5.8 months (IQR 3.7-22.0) for IEA (P=0.043). Endoscopic resection was curative in 87.5% of patients with an ACA, 82.3% in patients with an LSA and in only 9.1% of patients with an IEA (P <0.001). Recurrence occurred in 9 patients (10.7%), 5 of them had a localized adenoma, 3 patients with an LSA and 1 patient with an IEA (P=0.875). Endoscopic ampullectomy is a safe and successful treatment in patients with an adenoma with or without a lateral spreading growth pattern. In case of an intraductal extended adenoma endoscopic success rates are significantly lower.