Impact of 5-Year Endoscopic Surveillance Intervals with Biopsy following Endoscopic Papillectomy for Ampullary Adenoma

Abstract

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

Machine learning models for predicting survival in patients with ampullary adenocarcinoma

“…Previous research has used various types of prediction models to assess the short-term survival rates of AAC, including Kaplan–Meier survival analysis, logistic regression, and the Cox proportional hazards (CoxPH) model. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Kaplan–Meier survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of non-informative censoring. 24 , 25 Logistic regression models aim to estimate the relationship between potential factors and survival outcomes as well as adjust for confounders.…”

“…Previous research has used various types of prediction models to assess the shortterm survival rates of AAC, including Kaplan-Meier survival analysis, logistic regression, and the Cox proportional-hazards (CoxPH) model [5][6][7][8][9][10][11][12][13][16][17][18][19][20][21][22][23] . Kaplan-Meier J o u r n a l P r e -p r o o f survival analysis is the most commonly method used to investigate the prognostic factors for AAC, which does not allow adjustments for confounders and has a restrictive assumption of noninformative censoring 24,25 .…”