Clinical outcomes of endoscopic papillectomy for ampullary adenoma and adenocarcinoma: a multicenter retrospective study in Japan

BACKGROUND AND AIMS: Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary epithelial tumors. However, clinical outcomes and predictors of recurrence remain unclear. METHODS: We conducted a multicenter, retrospective cohort study at 22 tertiary centers in Japan, including patients who underwent EP between January 2009 and December 2020. The primary outcome was cumulative recurrence in patients with histologically confirmed adenoma or adenocarcinoma. Recurrence predictors were evaluated using Cox proportional hazards model. RESULTS: Of 875 patients, 798 had confirmed ampullary epithelial tumor, and 776 were included in the long-term outcome analysis. The 3-year cumulative recurrence rate was 20%. Indeterminate (Rx) and positive (R1) resection margins were independently associated with higher recurrence compared with negative margins (R0), with hazard ratios of 2.30 (95% CI, 1.44-3.68) and 2.95 (95% CI, 1.85-4.71), respectively. R0 resection was achieved in 52.1% (416/798) of patients, with a 3-year cumulative recurrence rate of 11% (95% CI, 7.6%-15%). CONCLUSIONS: Recurrence after EP for ampullary epithelial tumors is common, even after R0 resection. These findings highlight the need for long-term surveillance following EP.