P0025 - The Outcomes of Ampullary Adenomas in Observation Without Intervention, Endoscopic Papillectomy, and Surgical Intervention

Jeffrey H. Lee, MD, MPH¹, Nicole Johnston, MD², Iyad S.. Al-Bustami, MD³, Daniel J. Low, MD¹, William A Ross, MD¹, Emmanuel Coronel, MD¹, Phillip Ge, MD¹, Brian R. Weston, MD^1
1University of Texas MD Anderson Cancer Center, Houston, TX; ²MD Anderson Cancer Center, Houston, TX; ³University of Texas Health Science Center at Houston, Houston, TX

Introduction: Ampullary adenomas (AAs) can occur in a sporadic setting (SA) or genetic conditions, such as FAP and HNPCC. We aim to share the long-term follow-up data on observation without intervention, endoscopic intervention, and surgical intervention.

Methods: This is a retrospective study of all patients with pathology-confirmed AAs from 1987 to 2023 at a tertiary cancer center.

Results: Of 256 patients with AAs (188 FAP/HNPCC and 68 SA) with a mean follow-up of (MFU) 4.79 (+ 6.55)y, 170 were under observation (151 FAP/HNPCC, 19 SA) with MFU 4.47 (+ 6.12)y, 64 underwent endoscopic intervention [63 endoscopic papillectomy (EP) and 1 argon plasma coagulation (APC)] with MFU 6.05 (+ 7.42)y, and 23 surgery [20 pancreaticoduodenectomy (PD) with MFU 3.93 (+ 7.72)y and 3 surgical ampullectomy with MFU of 6.23 (+ 7.67) y. During the follow-up period, none of our 256 patients died from AAs. None of the 170 patients in the observation group developed cancer during the follow-up although 12% underwent endoscopic or surgical intervention due to progression of advanced adenomas in 5 years. For EP, the mean size of ampullary mass was 21.7 + 11.4 mm.The technical success rate of EP was 62/63 (98.4%) with en bloc resection rate 33/63 (52.4%). Deep margins were negative 53/63 (84.1%). In en bloc resection (33/63), deep and lateral margins were negative in 26/33 (78.8%). Pancreatic duct stent was placed in all patients who underwent EP. The complications of EPs include mild pancreatitis in 4 (6.3%) and cholangitis 1 (1.6%). Endoscopy post-EP was done at 3m, at 1y, and then yearly thereafter. The recurrence of AAs after EPs was 11/63 (17.5%) in 1,094.6 (198-3,013)d. Secondary intervention of EP for development of HGD was performed in 8 (7 from EP and 1 from surgical ampullectomy), APC treatment in 4 (all from EP), and PD in 8 (6 from EP and 2 from surgical ampullectomy) in 737.5 d (125-3013)d.The 3 surgical ampullectomy patients ended up having EP in 1 and PD in 2.The complications of surgical intervention were 10/33 (43.5%) comprising 5 pancreatic leak, 1 bile leak, and 4 abscesses.

Discussion: When observation was chosen for AAs in FAP/HNPCC, progression of adenoma that needed intervention occurred in 5 years without observing any developing adenocarcinoma. EP had a high technical success rate with low adverse events, but with a high recurrence rate. Surgical intervention had a low recurrence rate but high adverse events. These findings should be considered when managing AAs, especially in hereditary conditions.




Disclosures:


Jeffrey H. Lee, MD, MPH¹, Nicole Johnston, MD², Iyad S.. Al-Bustami, MD³, Daniel J. Low, MD¹, William A Ross, MD¹, Emmanuel Coronel, MD¹, Phillip Ge, MD¹, Brian R. Weston, MD¹. P0025 - The Outcomes of Ampullary Adenomas in Observation Without Intervention, Endoscopic Papillectomy, and Surgical Intervention, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.