Clin Endosc.  2020 Nov;53(6):659-662. 10.5946/ce.2019.171.

Management of Remnant or Recurrent Lesions after Endoscopic Papillectomy

• Yasuda I
• Kobayashi S
• Takahashi K
• Nanjo S
• Mihara H
• Kajiura S
• Ando T
• Tajiri K
• Fujinami H

• KMID: 2511225
• DOI: http://doi.org/10.5946/ce.2019.171

Abstract

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery.

Keyword

Ampullary adenoma; Argon plasma coagulation; Endoscopic papillectomy; Radiofrequency ablation

Reference

1. Rustagi T, Irani S, Reddy DN, et al. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest Endosc. 2017; 86:170–176.

2. Kang SH, Kim KH, Kim TN, et al. Therapeutic outcomes of endoscopic papillectomy for ampullary neoplasms: retrospective analysis of a multicenter study. BMC Gastroenterol. 2017; 17:69.

3. ASGE Standards of Practice Committee, Chathadi KV, Khashab MA, et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc. 2015; 82:773–781.

4. Espinel J, Pinedo E, Ojeda V, Guerra Del Río M. Endoscopic ampullectomy: a technical review. Rev Esp Enferm Dig. 2016; 108:271–278.

5. Nam K, Song TJ, Kim RE, et al. Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma. Dig Endosc. 2018; 30:485–492.

6. Sakai A, Tsujimae M, Masuda A, et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol. 2019; 25:1387–1397.

7. Klein A, Qi Z, Bahin FF, et al. Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent. Endoscopy. 2018; 50:972–983.

8. van der Wiel SE, Poley JW, Koch AD, Bruno MJ. Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study. Surg Endosc. 2019; 33:1180–1188.

9. Bohnacker S, Seitz U, Nguyen D, et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005; 62:551–560.

10. Ridtitid W, Tan D, Schmidt SE, et al. Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc. 2014; 79:289–296.

11. Kim JH, Moon JH, Choi HJ, et al. Endoscopic snare papillectomy by using a balloon catheter for an unexposed ampullary adenoma with intraductal extension (with videos). Gastrointest Endosc. 2009; 69:1404–1406.

12. Dzeletovic I, Topazian MD, Baron TH. Endoscopic balloon dilation to facilitate treatment of intraductal extension of ampullary adenomas (with video). Gastrointest Endosc. 2012; 76:1266–1269.

13. Valente R, Urban O, Del Chiaro M, et al. ERCP-directed radiofrequency ablation of ampullary adenomas: a knife-sparing alternative in patients unfit for surgery. Endoscopy. 2015; 47 Suppl 1:E515–E516.

14. Mehendiratta V, Desilets DJ. Use of radiofrequency ablation probe for eradication of residual adenoma after ampullectomy. Gastrointest Endosc. 2015; 81:1055–1056.

15. Camus M, Napoléon B, Vienne A, et al. Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy: a multicenter prospective study. Gastrointest Endosc. 2018; 88:511–518.