A sequential strategy of upfront radiofrequency ablation followed by endoscopic papillectomy for complex ampullary...

Endoscopic papillectomy (EP) is the first-line treatment for ampullary tumors, and radiofrequency ablation (RFA) as an alternative or adjunctive treatment. This study systematically analyzed EP's clinical outcomes and evaluated the feasibility and safety of a sequential RFA-first strategy for complex ampullary tumors.

We retrospectively analyzed 132 patients treated with EP or RFA at Shenzhen People's Hospital from April 2018 to August 2024. Categorical variables were presented as frequencies (percentages), and continuous variables as mean ± Standard Deviation (SD). Binary logistic regression analyzed risk factors. Propensity score matching and analysis of variance (ANOVA) compared adverse events between treatments.

Initially, 123 of 132 patients underwent EP, while 9 received RFA as the initial treatment due to tumors >3 cm, peri-diverticular lesions, and intraductal invasive lesions. The technical success rate was 100%, and the overall short-term clinical success rate was 96.6%. Adverse events occurred in 20.5% of the patients. Tumor size was identified as a significant risk factor for adverse events such as postprocedural pancreatitis (p = 0.03), intraprocedural bleeding (p < 0.001), and postprocedural bleeding (p = 0.024). The short-term clinical success rate of the RFA group was 91.7%, while adverse events were observed in 16.7% of the patients. Significantly, our findings revealed a statistically no significant difference in adverse events between the RFA and non-RFA groups (p = 0.719).

An upfront RFA strategy followed by staged EP or additional RFA may be a potentially feasible and safe method to reduce adverse events in select patients with complex ampullary tumors. However, long-term efficacy and late complication rates require further evaluation with extended follow-up.