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

The study analyzed treatment outcomes in 132 patients with ampullary tumors using endoscopic papillectomy (EP) or radiofrequency ablation (RFA) from April 2018 to August 2024. Initially, 123 patients underwent EP, while 9 patients with complex tumors (larger than 3 cm, peridiverticular lesions, and intraductal invasive lesions) received RFA as first-line treatment. Technical success rate was 100% and overall short-term clinical success rate reached 96.6%. Adverse events occurred in 20.5% of patients, with tumor size identified as a significant risk factor. In the RFA group, clinical success rate was 91.7% with adverse events in 16.7% of patients. No statistically significant difference in adverse events was found between the RFA and non-RFA groups. The results suggest that an upfront RFA strategy followed by EP or additional RFA may be a safe and feasible method to reduce complications in selected patients with complex ampullary tumors.