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• W2977633953 abstract "Introduction: The increased application of screening and diagnostic upper endoscopy has increased the frequency of identified premalignant ampullary lesions. These premalignant lesions need extirpation to derail the adenoma to carcinoma sequence. Extirpative ampullectomy, whether endoscopic or operative, should be definitive treatment. However, the recurrence rates after polypectomy and the number of interventions to rid the polyp are not established. We undertook this study to determine the utility of and outcomes after endoscopic vs. operative ampullectomy. Methods: From 2002 to 2011, 35 patients underwent operative transduodenal ampullectomy and 38 patients underwent endoscopic ampullectomy per American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Follow ups were conducted 6 months post operatively. Median data are presented. Results: Patients undergoing operative vs. endoscopic therapy were similar in sex, age, BMI, and pretreatment evaluation. Transduodenal ampullectomy was undertaken for larger polyps than endoscopic polypectomy (2.1cm vs. 1.5cm respectively, p < 0.001). 97% of transduodenal ampullectomies had microscopically negative (R0) margins. R margins obtained during endoscopic ampullectomies were inconclusive. 29/35 (82%) of patients treated with transduodenal ampullectomy were without disease at last follow-up. 6/35 (17%) patients had recurrent or persistent disease with one patient succumbing to their disease. 16/38 (42%) patients treated endoscopically were without disease at last follow-up, though 7 patients were lost to follow-up. 15/38 (39%) had residual or recurrent disease despite numerous endoscopic reinterventions. Excluding patients in the endoscopic cohort with a history of familial adenomatous polyposis (21%), recurrence rate was 10/30 (33%). Conclusion: Recurrence after endoscopic resection is higher than after transduodenal ampullectomy, even in a non-FAP setting. R0 margins are hard to confirm endoscopically and should not be used as a predictor of recurrence. The more aggressive approach, a surgical option may be better suited for patients with larger polyps (>2 cm) and less comorbidities. Because the approach is less invasive, endoscopic ampulectomy may be more suitable for patients who suffer from FAP as it is highly recurrent and may require multiple interventions. Clinicians have to be aware of and educate patients regarding the possibility of residual disease and recurrence after both surgical and endoscopic ampullectomy for ampullary adenoma." @default.
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• W2977633953 date "2015-10-01" @default.
• W2977633953 modified "2023-09-27" @default.
• W2977633953 title "Outcomes Following Endoscopic Versus Transduodenal Ampullectomies for Ampullary Adenomas Presidential Poster" @default.
• W2977633953 doi "https://doi.org/10.14309/00000434-201510001-00072" @default.
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