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• W3033503907 abstract "Ampullary adenomas are a frequent manifestation of familial adenomatous polyposis (FAP). Intervention is not required unless they are symptomatic, > 10 mm, demonstrate rapid growth, or advanced neoplasia. Management includes endoscopic papillectomy and surgical transduodenal ampullectomy, which may be preferred to more radical options in this population given prior colectomy and desmoid disease. No consensus on the optimal management of ampullary adenomas, as few data regarding the safety and efficacy of endoscopic papillectomy exist. Our study aims to evaluate the safety and efficacy of endoscopic papillectomy in patients with FAP. We identified patients who underwent endoscopic papillectomy as the first intervention for ampullary adenoma between 1/2004 and 11/2019 at a quaternary referral center. Medical records were used to determine demographics, endoscopy details, histopathology, complications (as defined by ASGE guidelines), and endoscopic follow up (date of most recent endoscopy – date of endoscopic papillectomy). Postprocedural complications occurred within 14 days of the procedure, and late complications occurred thereafter. Continuous variables are reported as mean ± standard deviation, or median [interquartile range; IQR]. 33 patients were identified. 22/33 (67%) were male, and 31/33 (97%) were white. Age at intervention was 42.9 ±14.9 years, 31/33 (94%) had prior colonic resection (19/33 total proctocolectomy, 10/33 colectomy with ileorectal anastomosis, 2/33 subtotal colectomy), and Charlson comorbidity index was 0.91 ±1.2. Median follow up after resection was 60.1 months [21.2 - 92.4]. Procedural characteristics are outlined in Table 1. Complications were noted in 17/33 (52%) patients, most frequently pancreatitis. One patient was found to have ampullary carcinoma after initial resection and underwent pancreaticoduodenectomy. Initial resection was successful by no macroscopic evidence of disease in 30/33 (91%) patients, with 2 patients requiring ablation of residual polyp, and 1 patient being referred for transduodenal ampullectomy. Recurrence was noted in 27/33 (82%) patients on follow up (Table 2), with median time to recurrence at 11.6 months [5.7, 33.1]. 7 patients underwent repeat endoscopic resection, of which 3/7 were not successful due to scarring. 5/7 were initially successful, but of these, 3 have had recurrent adenomas, and 1 patient suffered post-procedural pancreatitis. Endoscopic papillectomy of ampullary adenomas in FAP patients demonstrates a high recurrence and complication rate. Repeated endoscopic resection of recurrent adenomas has been largely unsuccessful due to scarring or recurrence, although few patients have required surgical intervention. The management of ampullary adenomas in FAP presents a challenge, and evaluation of methods to reduce recurrences are warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3033503907 date "2020-06-01" @default.
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• W3033503907 title "Tu1527 RECURRENCE AND COMPLICATIONS ARE COMMON AFTER ENDOSOCPIC RESECTION OF AMPULLARY ADENOMAS IN FAMILIAL ADENOMATOUS POLYPOSIS" @default.
• W3033503907 doi "https://doi.org/10.1016/j.gie.2020.03.3699" @default.
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