Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy : a multicenter prospective study.Camus M, Napoléon B, Vienne A, Le Rhun M, Leblanc S, Barret M, Chaussade S, Robin F, Kaddour N, Prat F. Gastrointest Endosc. 2018 Apr 13. [Epub ahead of print]



BACKGROUND:and study aims: Endobiliary dysplasia may persist after endoscopic papillectomy. Intraductal radiofrequency ablation (ID-RFA) is a potential alternative to complementary surgery. The aim of the study was to evaluate the efficacy and safety of ID-RFA for the treatment of adenomatous intraductal residue after endoscopic papillectomy.

PATIENTS AND METHODS:A prospective open-label multicenter study included patients with histologically proven endobiliary adenoma remnant (ductal extent <20 mm), after endoscopic papillectomy for ampullary tumor. RFA (effect 8, power 10 Watts, 30s) was performed during ERCP. Biliary ± pancreatic stent was placed at the end of the procedure. Endpoints were (1) the rate of residual neoplasia (ie, low-grade dysplasia-LGD, high-grade dysplasia-HGD, or invasive carcinoma) at 6 and 12 months; (2) rate of surgery, and (3) adverse events.RESULTS:Twenty patients (67 years (±11), 12 men) were included. The endobiliary adenoma was in LGD in 15 patients, and HGD in 5 patients. All underwent one successful ID-RFA session with biliary stent placement and recovered uneventfully. Five (25%) received a pancreatic stent. The rates of residual neoplasia were 15% and 30% at 6 and 12 months, respectively. Only 2 patients (10%) were referred for surgery. Eight patients (40%) experienced at least 1 adverse event between ID-RFA and 12 months of follow-up. No major adverse event occurred. HGD at inclusion was associated with higher dysplasia recurrence at 12 months (p=0.01).CONCLUSIONS:ID-RFA of residual endobiliary dysplasia after endoscopic papillectomy can be offered as an alternative to surgery, with a 70% chance of dysplasia eradication at 12 months after a single session and a good safety profile. Patient follow-up remains warranted after ID-RFA.


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