Endoscopic papillectomy and KRAS expression in the treatment of adenoma in the major duodenal papilla. (November 2015)

• Record Type: Journal Article
• Authors: Haraldsson, Erik; Swahn, Fredrik; Verbeke, Caroline; Mattsson, Johanna S.M.; Enochsson, Lars; Ung, Kjell-Arne; Lundell, Lars; Heuchel, Rainer; Löhr, J.-Matthias; Arnelo, Urban
• Is Part Of: Scandinavian journal of gastroenterology. Volume 50:Number 11(2015)
• Page Start: 1419
• Page End: 1427
• Publication Date: 2015-11
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Objective.</italic> </bold> The use of endoscopic papillectomy for resecting adenomas in the major duodenal papilla is increasing. This study focuses on the following three issues: Can endoscopic papillectomy be performed as a safe diagnostic and/or therapeutic procedure in biopsy-verified or suspected ampullary adenoma? Does expression of mutated <italic>KRAS</italic> in resected adenomatous tissue predict long-term outcome? What other factors may affect long-term outcome and should, therefore, be considered in decision making prior to endoscopic papillectomy? <bold><italic>Material and methods.</italic></bold> Thirty-six prospectively collected patients who underwent endoscopic papillectomy at Karolinska University Hospital between 2005 and 2014 were analyzed. <bold><italic>Results.</italic></bold> The rate of exact agreement between the histomorphological grading of the endoscopic biopsies and the papillectomy specimens was low (48%). Obstructive jaundice at presentation increased the risk of undetected adenocarcinoma (RR = 3.98; 95% CI = 1.46–10.85, <italic>p</italic> = 0.007). Lesions with malignancies were significantly larger (mean 30.6 mm) than those where only adenomas were found (mean 14.4 mm, <italic>p</italic> = 0.001). Mutated <italic>KRAS</italic> was detected in 9 of the 36 post-papillectomy specimens, including 4 of the 5 cases of ampullary adenocarcinoma. Eighteen cases were endoscopically cured after a mean follow-up period of 47 months (range 16–92 months). <bold><italic>Conclusions.</italic></bold> Endoscopic papillectomy is a valuable staging tool because of the limitations of endoscopic biopsy. Endoscopic papillectomy concomitantly offers a curative treatment for most patients with adenoma in the major duodenal papilla. Jaundice at presentation and large adenomas may indicate the presence of more advanced disease. Determination of mutated <italic>KRAS</italic> seems to be of limited value in predicting long-term outcome.</p> </abstract>