The Efficacy and Safety of Endoscopic Papillectomy Combined With Endobiliary Radiofrequency Ablation for Ampullary Neoplasms With Intraductal Biliary Extension

Abstract

Background and aimsEndoscopic papillectomy is the preferred approach for management of ampullary adenomas. Endobiliary radiofrequency ablation (RFA) is an ablative therapy that has been used to treat malignant biliary strictures. The aim of this study was to evaluate the safety and efficacy of endoscopic papillectomy combined with endobiliary RFA for ampullary neoplasms with intraductal biliary extension. MethodsThis international multicenter retrospective study included patients with histologically proven ampullary neoplasms with intraductal biliary extension treated with endobiliary RFA. Descriptive statistics were used to characterize patient characteristics, endoscopic features, and recurrence. ResultsIn all, 8 patients (mean age: 75.9 ± 4.9 years; 5 males) were included in this study. EUS was performed in all cases prepapillectomy and the mean size of the lesion was 29.7 (SD 12.6) mm with a mean intraductal extension length of 14.4 (SD 4.2) mm. Histology consisted of adenocarcinoma in 5 patients (67.5%) and high-grade dysplasia in 3 patients (37.5%). A range of 1-3 RFA sessions was performed with biliary stent placement. For surveillance after completion of therapy, patients received a mean of 4.1 (SD 1.64) ERCPs with intraductal biopsy over a mean follow-up period of 28.5 (SD 10.4) months. Recurrence occurred in 2 (25%) patients at 14 and 20 months (both with adenocarcinoma initially), respectively (incidence rate of 15.8%/year). ConclusionEndoscopic papillectomy combined with intraductal RFA may be an effective and safe treatment for ampullary neoplasms with intraductal extension, particularly for patients who are poor surgical candidates. Given the risk of recurrence, indefinite surveillance is recommended.