Researchers at Seoul St. Mary's Hospital have confirmed the safety of using radiofrequency ablation for treating duodenal adenoma with little chances of relapse.

The duodenum, which is the beginning of the small intestine, is an organ that plays an important role in the digestion of food.

While tumors that occur in the ampulla, where the pancreatic duct and bile duct join together to drain into the duodenum, they are not very common and have a frequency of 0.04 to 0.12 percent in autopsy studies, they account for a significant number of tumors in the small intestine.

Adenoma in ampulla is a lesion that can progress to cancer. In the past, hospitals performed surgical methods, such as pancreatic duodenal resection, to remove the adenoma. Due to the pancreatic biliary tract's complex anatomical structure, however, the mortality and morbidity after pancreatic duodenal resection have become a problem, forcing hospitals to turn to endoscopic resection as a new form of treatment.

The problem is that adenoma recurrence after endoscopic resection is common, with 30 percent seeing relapses. Also, ampulla adenoma may invade the bile or pancreatic duct, making it difficult to complete endoscopic resection.

To resolve this issue, the team, led by Professors Lee In-seok and Choi Young-hoon at the hospital, turned to radiofrequency ablation as a safer treatment to remove adenomas in the ampulla.

The research team investigated 10 cases of patients who underwent radiofrequency ablation treatment due to remaining or recurring lesions among patients treated with endoscopic resection at Seoul St. Mary's Hospital from November 2017 to June 2019. As a result, there were no serious side effects, and the team managed to confirm the treatment's safety.

Nine patients showed no relapses during an average follow-up period of about 8.4 months (253 days). One patient had to receive surgical treatment after the hospital found an adenoma with severe dysplasia.

In the study, the team also used a radiofrequency ablation using a new electrode to limit the maximum temperature. In conventional radiofrequency ablation, the risk of damage to the normal tissue around the lesion more than necessary is high due to excessive temperature.

The long cylindrical electrode used the team's radiofrequency ablation is suitable for insertion into the bile duct and pancreatic duct, making it the best option for treating adenoma that remains in the bile duct or pancreatic duct or recurs after endoscopic resection of ampulla adenoma.

"Treatment is difficult if there is an adenoma in the bile or pancreatic duct after endoscopic resection of ampulla adenoma," Professor Lee said. "The study is significant as it expanded the area of endoscopic treatment by proving the safety of radiofrequency ablation using a new electrode with a low recurrence rate and less severe side effects."

The journal Gut and Liver has published the results of the study.