Endoscopic surveillance and ablative therapy for periampullary adenomas

OBJECTIVES: Periampullary adenomas are an increasingly recognized condition , both in those with familial adenomatous polyposis syndromes (FAP) as well as sporadic cases. Endoscopic management has been advocated for these lesi ons without differentiating between these two patient groups regarding aim of therapy. The aims of this study were to determine the safety and effecti veness of endoscopic surveillance and ablative therapy of periampullary ade nomas in patients with both sporadic and FAP-associated lesions. METHODS: Retrospective analysis of 59 patients with FAP and 32 with sporadi c lesions who were all enrolled in a program of endoscopic surveillance and ablative therapy. Median follow-up was 24 months (range, 1-134 months). RESULTS: Ampullary ablative therapy has resulted in return to normal histol ogy in 44 and 34% of sporadic and FAP-associated lesions, respectively. Com plications of endoscopic therapy were mild in 12 patients and severe in 3 p atients: the latter category involved one occurrence of asymptomatic duoden al stenosis and one occurrence of postcoagulation syndrome-both after Nd-YA G laser therapy-and necrotizing pancreatitis after ampullary biopsy in one patient. Thirteen patients have been referred for surgical intervention. Th ere has been no mortality and no cases of advanced malignancy missed by end oscopy. CONCLUSIONS: Endoscopic surveillance and ablative therapy of periampullary lesions is safe and can be effective, although eradication of ampullary tis sue requires multiple ablative sessions. (Am J Gastroenterol 2001;96:101-10 6. (C) 2001 by Am. Coll. of Gastroenterology).