Radiofrequency ablation for intraductal extension of ampullary adenomatous lesions: proposal for a standardized protocol

Background and study aims Intraductal extension of\r\nampullary adenoma represents a challenging endoscopic\r\nissue. Intraductal radiofrequency ablation (RFA) has been\r\nrecently suggested, but evidence and standardization of\r\nthis technique are still lacking. This study aimed to provide\r\na long-term evaluation of clinical efficacy and safety of intraductal\r\nRFA ablation with a standardized algorithm of\r\ntreatment.\r\nPatients and methods Data were prospectively collected\r\nfrom consecutive patients with intraductal extension of\r\nadenomatous ampullary lesions from January 2016 to November\r\n2018. Endpoints of the study were clinical success\r\nevaluated on histology results at the last follow-up, technical\r\nsuccess, and adverse events assessment.\r\nResults Nine patients with intraductal (biliary ± pancreatic)\r\nextension of ampullary adenomas were treated with\r\nRFA during the study period. Histology on the papillectomy\r\nspecimen confirmed intraductal involvement with lowgrade\r\ndysplasia (LGD) in five cases (56%), high-grade dysplasia\r\n(HGD) in three (33%), and HGD with intramucosal\r\nadenocarcinoma in one patient (11 %). Additional argon\r\nplasma coagulation to ablate the adenoma on the duodenal\r\nmucosa was applied in five patients (56%). Technical success\r\nwas 100 %. One patient (11%) with failed pancreatic\r\nstenting, developing acute pancreatitis after RFA, recovered\r\nwith medical therapy. After a median follow-up of 21\r\nmonths (IQR 20–31), six patients (67%) achieved clinical\r\nsuccess being free of recurrence, whereas one was diagnosed\r\nwith persistence of adenocarcinoma, one with recurrent\r\nHGD, and one with recurrent LGD.\r\nConclusions In our experience, intraductal RFA achieved\r\nacceptable results after a 2-year follow-up. Further studies\r\nare required to confirm our results and to select those patients\r\nmost likely to respond.