High frequency of colorectal neoplasia in patients with sporadic adenomas or adenocarcinomas of the papilla of Vater: The same adenoma-carcinoma sequence?

Background: Data on the frequency of colorectal neoplasia in sporadic ampullary tumors remains scarce. Methods: We retrospectively reviewed 135 patients undergoing endoscopic ampullectomy from January 2018 to July 2021, and identified 95 patients with sporadic ampullary adenoma who underwent total colonoscopy. Colonoscopy findings were compared with 380 asymptomatic controls using the chi-squared test. Whole-exome sequencing (WES) was performed on one patient with synchronous adenomas of the ampulla of Vater and ascending colon.Results: Colorectal polyps were present in 60% of Cases vs. 34.7% of Controls ( P = 0.001), advanced adenoma in 20% vs. 5.5%, and adenocarcinoma in 4.2% vs. 0.8%. Cases tended to have larger polyps than Controls ( P < 0.001), while there was no difference in polyp location and histology between the two groups. The odds ratio of all the colorectal lesions, advanced colorectal adenoma and adenocarcinoma in C ases was 1.7, 4.2, and 4, respectively. WES in one patient revealed that both of ampullary adenoma and colonic adenoma shared somatic ABCB1 mutation.Conclusions: The frequency of colorectal polyps or neoplasia was significantly higher in Cases than Controls . We proposed that ampullary neoplasia is analogous to colon lesions and warrants total colonoscopy screening in patients diagnosed with ampullary tumors.(c) 2022 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

Retrospective study found that the frequency of colorectal polyps and neoplasia is significantly higher in patients with sporadic ampullary tumors compared to asymptomatic controls. It is proposed that ampullary tumors are analogous to colon lesions and total colonoscopy screening is recommended for patients diagnosed with ampullary tumors.