Aims
Endoscopic papillectomy (EP) for papillary adenoma is effective but is
compromised by recurrence rates exceeding 20%. Data on managing recurrence is scant. We evaluated risk factors for recurrence and its management.
Methods
Patients with histologically confirmed major papilla adenomas treated by EP at a tertiary center over 164 months to November 2024 were included. Residual or recurrent adenoma (RRA) was defined histologically. Treatments included hot snare excision and cold avulsion with snare tip soft coagulation(CAST). Margin thermal ablation(MTA) using snare tip soft coagulation(STSC) was used at index EP from 2020. Success was defined as negative endoscopic and histologic biopsy at the EP site during follow-up.
Results
Inclusion criteria were met by 166/215 EP cases. Surveillance endoscopy was
performed in 162(97.6%), with RRA observed in 39 (24.1%). Multivariable logistic regression identified larger lesion size(OR 1.041/1mm;p=0.0239), intraductal extension(OR 3.919;p=0.010), and familial adenomatous polyposis (FAP)(OR 6.60;p=0.0029) as risk factors for RRA. MTA was protective (OR 0.229;p=0.0203). RRA treatment was performed in 37/39 (94.6%). Intraductal recurrence was excluded as a specialised subgroup. 31 patients were treated for RRA with hot snare or CAST +/- MTA. In 28 patients with median follow-up 22months, 25(89.3%) were cured. Adverse events were pancreatitis 2 and delayed bleed 1. No patient required surgical treatment for RRA.
Conclusions
After EP for papillary adenoma, RRA occurs in 24%. Risk factors include lesion size, intraductal extension and FAP. MTA reduces the risk of RRA. Endoscopic treatment of RRA is safe, effective and durable.