The usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma

Abstract

Background and aim

Endoscopic snare papillectomy (ESP) is an effective treatment for ampullary adenoma. Argon plasma coagulation (APC) is widely used as an additional method to control bleeding or ablate the residual tumor. However, the efficacy of this procedure has not yet been fully evaluated. This study aimed to evaluate the usefulness of APC as an additional method to ESP.

Methods

The patients who underwent ESP for ampullary adenoma between September 2005 and September 2015 were retrospectively reviewed. Using propensity score matching, we compared short- and long-term outcomes between ESP with additional APC group and ESP only group. Primary outcome was early post-ESP adverse events (AEs), and secondary outcome were late AEs and recurrence.

Results

Among 109 patients, additional APC was performed in 59 (54.1%) patients. After matching, 41 patients were included in both groups, respectively. Bleeding rate was significantly lower in ESP+APC group than ESP only group (7.3% vs. 31.7%, odds ratio = 0.180, P<0.01). However, there were no significant differences in other procedure-related early AEs such as pancreatitis (12.2% vs. 19.5%, P = 0.365), cholangitis (2.4% vs. 9.8%, P = 0.198), and perforation (2.4% vs. 2.4%, P = 1.000) between ESP+APC group and ESP only group. During the follow-up period (mean 904±868 days), papillary stricture (9.8% vs. 4.9%, P = 0.405) and recurrence rates (24.4% vs. 24.4%, P = 0.797) were not significantly different between ESP+APC group and ESP only group.

Conclusions

Additional APC during ESP may have beneficial effect by decreasing bleeding rate without harmful effect.

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