A0417 - Endoscopic Papillectomy for Familial Adenomatous Polyposis Syndrome vs Sporadic Lesions: Distinct Clinical Manifestations and Therapeutic Options

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Gaurav Suryawanshi, MD

University of Minnesota Medical Center
Minneapolis, MN

Gaurav Suryawanshi, MD¹, Mohamed Abdallah, MD¹, Nicholas McDonald, MD², David Jonason, MD¹, Guru Trikudanathan, MD¹, Stuart K. Amateau, MD, PhD¹, Shawn Mallery, MD¹, Martin L. Freeman, MD¹, Nabeel Azeem, MD¹
¹University of Minnesota Medical Center, Minneapolis, MN; ²University of Minnesota, Minneapolis, MN

Introduction: Patients with familial adenomatous polyposis (FAP) syndrome have a high risk of developing ampullary and periampullary adenomas and subsequently adenocarcinoma. Duodenal adenocarcinoma is the second leading cause of death in patients with FAP. Endoscopic papillectomy (EP) is the primary modality for managing ampullary lesions. This study aims to compare baseline characteristics and outcomes of EP between patients with FAP vs. sporadic ampullary lesions.

Methods: This study is a retrospective analysis of all consecutive patients who underwent endoscopic snare papillectomy for an ampullary lesion between January 2006 and December 2021. We compared baseline characteristics, clinical presentation, procedure-related variables, recurrence, and post-EP adverse events in patients with FAP vs. sporadic ampullary lesions.

Results: Fifty-one patients undergoing EP for ampullary lesions were included in the final analysis. There were eleven patients with FAP and forty patients with sporadic ampullary lesions. In FAP vs. sporadic ampullary lesions, patients were younger [35 vs. 70 years, P < 0.001], were less likely to present with symptoms prior to EP [18.2 vs. 62.5%, P=0.02], less likely to have biopsies prior to EP [54.5 vs. 85%, P=0.04], and less likely to get an endoscopic ultrasound prior to EP [36.4 vs.82.5%, P=0.005]. FAP patients were also less likely to be on antiplatelet or anticoagulation therapy [0 vs. 35%, P=0.02].

In FAP vs. sporadic ampullary lesions, the lesion size was smaller in FAP: 10 mm [IQR: 6-15 mm] vs. 15 mm [12-21 mm, P=0.03]. The en-bloc resection rate was higher in FAP vs. sporadic ampullary lesions [100 vs. 67.5%, P=0.01]. However, the rate of complete histological (R0) resection (45.5 vs. 45%, P=1.00] was similar. Although the recurrence rate was higher in FAP vs. sporadic ampullary lesions [55.6 vs. 32.4%, P= 0.2], this was not statistically significant. Also, the rates of adverse events were similar between the two groups.

Discussion: Patients with FAP and ampullary lesions requiring EP present earlier in life, are less likely to present with symptoms, have smaller lesions, and are more likely to have en-bloc resection than sporadic lesions. Although not statistically significant, rates of recurrence were higher in FAP thus prompt surveillance of these patients is necessary. EP is safe and effective in removing ampullary lesions irrespective of the type of lesion.

	FAP (n=11)	Sporadic (n=40)	P-value
Male gender	4 (3.4%)	25 (62.5%)	0.12
Age, years (median (IQR))	35 (30-63)	70 (61-76.75)	< 0.0001
Age > 75 years	0 (0%)	14 (35.0%)	0.02
Symptoms prior to EP	2 (18.2%)	25 (62.5%)	< 0.0001
Histology obtained prior to EP	6 (54.5%)	34 (85.0%)	0.04
Endoscopic ultrasound prior to EP	4 (36.4%)	33 (82.5%)	0.005
Antiplatelet/Anticoagulation use	0 (0%)	14 (35.0%)	0.02
Iron deficiency anemia	4 (36.4%)	11 (27.5%)	0.71
Extended procedure ( >90 mins)	1 (9.1%)	13 (37.1%)	0.39
Lesion size in mm (median (IQR))	10 (6-15)	15 (12-21)	0.03
Lesion size ≥ 20 mm	1 (9.1%)	16 (41.0%)	0.23
Intraductal invasion	1 (9.1%)	7 (17.5%)	0.67
En bloc resection	11 (100%)	27 (67.5%)	0.01
Complete histological (R0) resection	5 (45.5%)	18 (45.0%)	1.00
Final Pathology Adenoma Adenoma w/high grade dysplasia Adenocarcinoma or NET Other (benign)	10 (90.9%) 0 (0%) 0 (0%) 1 (9.1%)	29 (72.5%) 5 (12.5%) 3 (7.5%) 3 (7.5%)	0.4
More than one EP to achieve technical success	0 (0%)	7 (17.5%)	0.32
Recurrence after technical success	5 (55.6%)	12 (32.4%)	0.2
Delayed bleeding requiring intervention	2 (18.2%)	5 (12.5%)	0.64
Post-ERCP Pancreatitis (PEP)	3 (27.3%)	4 (10.0%)	0.16
Papillary Stenosis	0 (0%)	2 (5.0%)	1.00

Table: Table 1: Endoscopic papillectomy in patients with FAP v sporadic ampullary lesions. EP: Endoscopic papillectomy; FAP: Familial adenomatous polyposis; IQR: Interquartile range.

Disclosures:

Gaurav Suryawanshi indicated no relevant financial relationships.

Mohamed Abdallah indicated no relevant financial relationships.

Nicholas McDonald indicated no relevant financial relationships.

David Jonason indicated no relevant financial relationships.

Guru Trikudanathan: Boston Scientific Corporation – Consultant.

Stuart Amateau: Boston Scientific Corporation – Consultant. Merit Medical – Consultant. Olympus Medical – Advisor or Review Panel Member. Olympus Medical – Consultant. Steris – Consultant.

Shawn Mallery indicated no relevant financial relationships.

Martin Freeman: Boston Scientific Corporation – Consultant.

Nabeel Azeem: Boston Scientific – Consultant.

Gaurav Suryawanshi, MD¹, Mohamed Abdallah, MD¹, Nicholas McDonald, MD², David Jonason, MD¹, Guru Trikudanathan, MD¹, Stuart K. Amateau, MD, PhD¹, Shawn Mallery, MD¹, Martin L. Freeman, MD¹, Nabeel Azeem, MD¹. A0417 - Endoscopic Papillectomy for Familial Adenomatous Polyposis Syndrome vs Sporadic Lesions: Distinct Clinical Manifestations and Therapeutic Options, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.