Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort

Background Familial adenomatous polyposis (FAP) is a rare inherited syndrome that predisposes the patient to cancer. Treatment of FAP-related ampullary lesions is chal-lenging and the role of endoscopic papillectomy has not been elucidated. We retrospectively analyzed the outcomes of endoscopic papillectomy in matched cohorts of FAP-related and sporadic ampullary lesions (SALs).Methods This retrospective multicenter study included 1422 endoscopic papillectomy procedures. Propensity score matching including age, sex, comorbidity, histologic sub-type, and size was performed. Main outcomes were com-plete resection (R0), technical success, complications, and recurrence.Results Propensity score matching identified 202 patients (101 FAP, 101 SAL) with comparable baseline characteristics. FAP patients were mainly asymptomatic (79.2% [95 %CI 71.2-87 .3] vs. 46.5 % [95 %CI 36.6-56.4 ]); P < 0.001). The in-itial R0 rate was significantly lower in FAP patients (63.4% [95 %CI 53.8-72.9] vs. 83.2% [95 %CI 75.8-90.6]; P= 0.001). After repeated interventions (mean 1.30 per pa-tient), R0 was comparable (FAP 93.1 % [95 %CI 88.0-98.1] vs. SAL 97.0% [95 %CI 93.7-1 00]; P= 0.19). Adverse events occurred in 28.7 %. Pancreatitis and bleeding were the most common adverse events in both groups. Severe adverse events were rare (3.5 %). Overall, 21 FAP patients (20.8% [95 %CI 12.7-28 .8]) and 16 SAL patients (15.8% [95 %CI 8.6-23.1]; P = 0.36) had recurrence. Recurrences occurred later in FAP patients (25 [95 %CI 18.3-31 .7] vs. 2 [95 %CI CI 0.06-3.9] months). Conclusions Endoscopic papillectomy was safe and effec-tive in FAP-related ampullary lesions. Criteria for endo-scopic resection of ampullary lesions can be extended to FAP patients. FAP patients have a lifetime risk of relapse even after complete resection, and require long-time sur-veillance.