Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-019-05812-2 ORIGINAL ARTICLE Long‑Term Outcomes of Endoscopic Papillectomy for Ampullary Adenomas Nadav Sahar 1  · Rajesh Krishnamoorthi 1  · Richard A. Kozarek 1  · Michael Gluck 1  · Michael Larsen 1  · Andrew S. Ross 1  · Shayan Irani 1 Received: 10 May 2019 / Accepted: 20 August 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background and Aims Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas and has mostly replaced surgical local resection. Recent data have discussed the role of endoscopic removal of laterally spreading adeno- mas associated with ampullary adenomas. We evaluated our long-term results of endoscopic papillectomy for ampullary adenomas. Methods We retrospectively analyzed patients who underwent endoscopic papillectomy of biopsy-proven adenomas at our tertiary center between 1994 and 2017. Clinical success was defined as complete excision of an adenoma with no evidence of recurrence during follow-up, no evidence of cancer, and without the need for surgery. Results A total of 161 patients (73M/88F) with a mean age of 61 (range 19–93) were included. Mean adenoma size was 20 mm (range 5–70). In total, 114/161 patients continued endoscopic surveillance for a minimum of 6 months with a median follow-up of 30 months (range 6–283). Recurrent adenomas were diagnosed in 8 patients (7%) after a median of 36 months (range 12–138). Clinical success was 83%; 35 laterally spreading adenomas were treated, which were larger than adenomas confined to the papilla (mean size 38 mm vs 15 mm, P < 0.05) and required more piecemeal resections (77% vs 15%, P < 0.05). However, no difference was found in recurrence rates between the two groups (8% vs 4%, P = 0.26); 24/161 (15%) of patients had adverse events including bleeding (6%) and pancreatitis (7%). Conclusions Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas, including laterally spreading ones. Long-term surveillance demonstrates low recurrence rates at expert centers. Keywords Papillectomy · ERCP · Adenoma Introduction Neoplasms of the ampulla of Vater are uncommon with a reported prevalence of 0.04–0.12% based on autopsy stud- ies [1, 2]. Adenomas are the most common benign form of these tumors. They can occur in the setting of genetic pre- disposition, such as familial adenomatous polyposis (FAP) or, more commonly, appear sporadically. Most adenomas are diagnosed incidentally, yet some cases can cause symptoms such as biliary obstruction or relapsing pancreatitis. Due to their malignant potential, resection is advocated for most ampullary adenomas. Since first described in 1983 by Suzuki et al. [3], endo- scopic papillectomy has gradually replaced surgical exci- sion (either transduodenal surgical ampullectomy or pan- creaticoduodenectomy) as the favored treatment for most adenomas, with success rates exceeding 80% [4, 5]. It has comparable recurrence rates to local resection, and lower morbidity and mortality than pancreaticoduodenectomy [6]. Operative intervention is usually reserved for malignant lesions or adenomas with extensive intraductal involvement of the bile duct or pancreatic duct, although reports of endo- scopic resection of early-stage ampullary cancers and abla- tive therapies to intraductal adenomas have shown promising results in patients who are poor surgical candidates [7, 8]. However, endoscopic papillectomy is not risk-free, and even when performed in experienced high-volume centers, com- plication rates range between 15 and 20% [9, 10]. Careful selection of ampullary adenomas that may be amenable to * Nadav Sahar nadav.sahar@gmail.com 1 Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave, Seattle, WA 98101, USA