Ampullary Radiofrequency Ablation For The Treatment Of Residual And Recurrence Neoplasia After Endoscopic Papillectomy: Report Of A Tertiary Center

Aims Endoscopic papillectomy is the recommended treatment for adenoma, CIS and intramucosal adenocarcinoma of ampulla but incomplete margin and recurrence are common. Radiofrequency ablation (RFA) as a complementary treatment of papillectomy margin is an emerging technique. The goal of this study was to evaluate retrospectively feasibility and efficiency of this technique in our center.

Methods All patients who had a first ampullary RFA following papillectomy were included, between October 2015 and October 2019. Operable patients with adenocarcinoma on margin accepting surgery and intraductal extension longer than 5mm were excluded.

Primary endpoint was the clinical success defined by the absence of recurrence at papillectomy site macroscopically and/or histologically at 3, 6 and 12 months. Secondaries endpoints were number of sessions needed for clinical success, the early (<30 days) and late (> 30 days) complications. Eradication failure was defined by the use of more than 2 sessions.

Results Twelve patients (mean age 64.8 years), with a median follow up of 31 months (12–57) were included. RFA was performed on margin with low grade (5) or high-grade dysplasia (5), (CIS) (1) and pT1R1 adenocarcinoma for one patient refusing surgery.

At 3, 6 and 12 months, clinical success was 92 %, 83 % and 83 % (11/12, 10/12 et 10/12) with a median of 1.1 sessions of RFA (1-2). Two early complications (moderate pancreatitis and bleeding requiring new endoscopy), 5 (41.6 %) late complications (biliary stenosis managed endoscopically) were reported. Two stenosis occurred in patients with 2 and 3 EMR sessions.

Conclusions RFA is an effective treatment to eradicate residual ampulloma (83 % at 12 months) with few session required (1.1 on average). Late stenosis are the main complication (41 %) managed endoscopically. Additional mucosectomy may be a risk factor of stenosis.

Citation Dahel Y, Giovannini M, Pesenti C etal. eP315 AMPULLARY RADIOFREQUENCY ABLATION FOR THE TREATMENT OF RESIDUAL AND RECURRENCE NEOPLASIA AFTER ENDOSCOPIC PAPILLECTOMY: REPORT OF A TERTIARY CENTER. Endoscopy 2021; 53: S201.

Publication History

Article published online:
19 March 2021