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Radiofrequency ablation for intraductal extension of ampullary adenomatous lesions: proposal for a standardized protocol
Background and study aims Intraductal extension of ampullary adenoma represents a challenging endoscopic issue. Intraductal radiofrequency ablation (RFA) has been recently suggested, but evidence and standardization of this technique are still lacking. This study aimed to provide a long-term evaluation of clinical efficacy and safety of intraductal RFA ablation with a standardized algorithm of treatment.
Patients and methods Data were prospectively collected from consecutive patients with intraductal extension of adenomatous ampullary lesions from January 2016 to November 2018. Endpoints of the study were clinical success evaluated on histology results at the last follow-up, technical success, and adverse events assessment.
Results Nine patients with intraductal (biliary ± pancreatic) extension of ampullary adenomas were treated with RFA during the study period. Histology on the papillectomy specimen confirmed intraductal involvement with low-grade dysplasia (LGD) in five cases (56 %), high-grade dysplasia (HGD) in three (33 %), and HGD with intramucosal adenocarcinoma in one patient (11 %). Additional argon plasma coagulation to ablate the adenoma on the duodenal mucosa was applied in five patients (56 %). Technical success was 100 %. One patient (11 %) with failed pancreatic stenting, developing acute pancreatitis after RFA, recovered with medical therapy. After a median follow-up of 21 months (IQR 20–31), six patients (67 %) achieved clinical success being free of recurrence, whereas one was diagnosed with persistence of adenocarcinoma, one with recurrent HGD, and one with recurrent LGD.
Conclusions In our experience, intraductal RFA achieved acceptable results after a 2-year follow-up. Further studies are required to confirm our results and to select those patients most likely to respond.
Received: 16 November 2020
Accepted: 20 January 2021
Article published online:
22 April 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Chathadi KV, Khashab MA. ASGE Standards of Practice Committee. et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 2015; 82: 773-781
- 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 Binmoeller KF, Boaventura S, Ramsperger K. et al. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 1993; 39: 127-131
- 4 Vogt M, Jakobs R, Benz C. et al. Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up. Dig Liver Dis 2000; 32: 339-345
- 5 Haraldsson E, Swahn F, Verbeke C. et al. Endoscopic papillectomy and KRAS expression in the treatment of adenoma in the major duodenal papilla. Scand J Gastroenterol 2015; 50: 1419-1427
- 6 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
- 7 Ceppa EP, Burbridge RA, Rialon KL. et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg 2013; 257: 315-322
- 8 Cahen DL, Fockens P, de Wit LT. et al. Local resection or pancreaticoduodenectomy for villous adenoma of the ampulla of Vater diagnosed before operation. Brit J Surg 1997; 84: 948-951
- 9 Jordan PH Jr, Ayala G, Rosenberg WR. et al. Treatment of ampullary villous adenomas thatmay harbor carcinoma. J Gastrointest Surg 2002; 6: 770-775
- 10 Tran TC, Vitale GC. Ampullary tumors: endoscopic versus operative management. Surg Innov 2004; 11: 255-263
- 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 Aiura K, Imaeda H, Kitajima M. et al. Balloon-catheter-assisted endoscopic snare papillectomy for benign tumors of the major duodenal papilla. Gastrointest Endosc 2003; 57: 743-747
- 13 Pérez-Cuadrado-Robles E, Piessevaux H, Moreels TG. et al. Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms. United European Gastroenterol J 2019; 7: 369-376
- 14 Mehendiratta V, Desilets DJ. Use of radiofrequency ablation probe for eradication of residual adenoma after ampullectomy. Gastrointest Endosc 2015; 81: 1055-1056
- 15 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: E515-E516
- 16 Suarez AL, Coté GA, Elmunzer BJ. Adjunctive radiofrequency ablation for the endoscopic treatment of ampullary lesions with intraductal extension (with video). Endosc Int Open 2016; 4: E748-E751
- 17 Rustagi T, Irani S, Reddy DN. et al. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest Endosc 2017; 86: 170-176
- 18 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
- 19 Choi YH, Yoon SB, Chang JH. et al. The safety of radiofrequency ablation using a novel temperature-controlled probe for the treatment of residual intraductal lesions after endoscopic papillectomy. Gut Liver 2020; Jul 6. Epub ahead of print. DOI: 10.5009/gnl20043.
- 20 Desilets DJ, Dy RM, Ku PM. et al. Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc 2001; 54: 202-208
- 21 Catalano MF, Linder JD, Chak A. et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59: 225-232
- 22 Norton ID, Gostout CJ, Baron TH. et al. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 2002; 56: 239-243
- 23 Cho JH, Jeong S, Kim EJ. et al. Long-term results of temperature-controlled endobiliary radiofrequency ablation in a normal swine model. Gastrointest Endosc 2018; 87: 1147-1150