Endoscopic papillectomy; a retrospective international multicenter cohort study with long-term follow-up

Jeska A Fritzsche, Amir Klein, Maarten J Beekman, Jeanin E van Hooft, Mayenaaz Sidhu, Scott Schoeman, Paul Fockens, Michael J Bourke, Rogier P Voermans, Jeska A Fritzsche, Amir Klein, Maarten J Beekman, Jeanin E van Hooft, Mayenaaz Sidhu, Scott Schoeman, Paul Fockens, Michael J Bourke, Rogier P Voermans

Abstract

Background: Endoscopic papillectomy (EP) is considered a relatively safe and minimally invasive treatment for papillary adenomas. In the literature a significant risk for local recurrence is described. The aim of this study was to evaluate long-term recurrence rates and time-to-recurrence. Additionally, risk factors for recurrence, malignancy and adverse events were studied.

Methods: This is a retrospective study in consecutive patients with papillary adenomas who underwent EP in two tertiary referral hospitals between 2001 and 2018. Primary outcome was recurrence in patients with at least 1-year endoscopic follow-up. Secondary outcomes were surgery free survival, adverse events, and mortality within 30 days after the index procedure.

Results: A total of 259 patients were found eligible [median age 66 years, 130 male (50.2%)]. Forty-three patients were known with familial adenomatous polyposis (FAP) (16.6%). At least 1-year endoscopic follow-up was available in 154 patients with a total follow-up of 586 person-years and median of 40 months [interquartile range (IQR) 25-75]. Recurrence occurred in 24 cases (15.6%) of which 8 were known with FAP, leading to a recurrence incidence rate of 4.1 per 100 person-years with a median time-to-recurrence of 29 months (IQR 14.75-59.5). Fifty-three patients underwent at least 5-year follow-up, in 6 (11.3%) of them recurrence was encountered after 5 years of which four were known with FAP. No risk factors for recurrence could be identified. Adverse events occurred in 50/259 patients (19.3%). One patient died within 30 days after the procedure. Papillary stenosis occurred in 19/259 (7.3%) of the patients. There were no cases of malignant degeneration during follow-up.

Conclusions: Recurrence after EP occurs in a significant proportion of patients and occurs even 5 years after EP. This emphasizes the need for long-term follow-up. We advise to consider at least 5-year follow-up in case of a sporadic adenoma, unless comorbidity makes follow-up clinically irrelevant.

Keywords: Endoscopic papillectomy; Long-term follow-up; Papillary adenoma; Recurrence.

Conflict of interest statement

Jeska A. Fritzsche, Amir Klein, Maarten J. Beekman, Mayenaaz Sidhu and Scott Schoeman have no conflicts of interest or financial ties to disclose. Jeanin E. van Hooft reports research grants from Cook Medical and Mylan and personal fees from Medtronics and Boston Scientific. Paul Fockens reports research grants from Boston Scientific and personal fees from Cook Medical, Ethicon Endo-surgery and Olympus Medical. Michael J. Bourke reports research grants from Olympus Medical, Cook Medical and Boston Scientific. Rogier P. Voermans reports research grants and personal fees from Boston Scientific. All outside the submitted work.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Screening and enrolment flowchart
Fig. 2
Fig. 2
Recurrence free survival in group with at least 1-year follow-up (n = 154)
Fig. 3
Fig. 3
Surgery free survival in all patients (n = 259)

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