title: Recurrences are common after endoscopic ampullectomy for adenoma in the familial adenomatous polyposis (FAP) syndrome.
abstract: BACKGROUND
  Endoscopic ampullectomy is increasingly performed in patients with familial adenomatous polyposis (FAP)-associated ampullary adenomas. We sought to define the procedure-associated morbidities and long-term outcomes.
  
  
  METHODS
  We performed a retrospective chart review of patients with FAP who underwent endoscopic ampullectomy at two tertiary institutions between 1999 and 2010. The severity of duodenal polyposis was classified according to Spigelman's classification.
  
  
  RESULTS
  Of 26 FAP patients who underwent endoscopic ampullectomy, 21 arose in the setting of Spigelman's stage II duodenal polyposis. Adverse events associated with endoscopic ampullectomy included acute pancreatitis (19.2%), abdominal pain (7.6%), and bleeding (3.8%). The mean resected adenoma size was 0.99 ± 0.34 cm. Three adenomas (12.0%) contained foci of high-grade dysplasia. Follow-up data were available for 24 patients. The mean follow-up duration was 84.5 ± 36.2 months. Adenoma recurrence was observed in 14 patients (58.3%; 14/24) at a mean of 38.3 months after initial ampullectomy. Adenomas ≥10 mm recurred more frequently than smaller adenomas (76.9 vs. 36.4%; p = 0.002). Positive margins were not associated with higher recurrence rates. No cancers were observed during long-term follow-up. Three patients underwent a Whipple procedure, but none was performed for a recurrent ampullary adenoma.
  
  
  CONCLUSIONS
  Endoscopic ampullectomy in FAP can be performed safely. Because ampullary adenomas frequently recur after endoscopic ampullectomy, close surveillance is essential. Smaller tumors are less likely to recur, suggesting a benefit for early recognition of these lesions.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Tianle
authors.initials: T
authors.lastname: Ma
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Jang
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Zukerberg
authors.forename: Robert
authors.initials: R
authors.lastname: Odze
authors.forename: Manish K
authors.initials: MK
authors.lastname: Gala
authors.forename: Peter B
authors.initials: PB
authors.lastname: Kelsey
authors.forename: David G
authors.initials: DG
authors.lastname: Forcione
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.forename: Brenna W
authors.initials: BW
authors.lastname: Casey
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Chung
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D003082:Colectomy / Q000706:statistics & numerical data; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult