Risk factors for the occurrence of ampullary tumors: A case‐control study

Abstract

Background:The incidence of ampullary tumors is increasing but data on association with an increased exposure to certain risk factors are scanty.Objective: To investigate risk and protective factors associated with the occurrence of ampullary tumors and whether these factors differ between ampullary tumors of the intestinal and pancreatobiliary subtypes or between adenomas and carcinomas. Methods:The association between a large set of exposome features and ampullary tumors occurrence was investigated in a bi-centric case-control study after ethic committee approval and power calculation. Results:In 223 histologically confirmed patients and 446 controls, previous cholecystectomy (odd ratio [OR] = 2.07; 95% confidence interval [CI] = 1.34-3.20) and proton pump inhibitors use (OR = 1.66; 95% CI = 1.16-2.37) were associated with increased risk of ampullary tumors, aspirin use (OR = 0.57; 95% CI = 0.36-0.90) and light alcohol intake (OR = 0.54; 95% CI = 0.38-0.76) with reduced risk. A previous cholecystectomy was also associated with tumors of intestinal subtype and with both adenomas and carcinomas, and proton pump inhibitors use with adenomas only. Smoking, body mass index, family history of cancers, previous ulcer, diabetes and use of statins, insulin and metformin were not significant factors. Conclusion:This is the first case-control study specifically highlighting factors associated with the occurrence of ampullary tumors. We report factors that are novel and plausible, in keeping with mechanisms described for other gastrointestinal tumors and with potential clinical relevance.

UEG week and UEG journal: A strong scientific liaison

“…In a case‐control study, Zaccari et al investigated risk factors for development of ampullary tumors 5 . Since the incidence of ampullary tumor is increasing, especially in younger adults, this study is particularly welcome.…”

“…In a case‐control study, Zaccari et al investigated risk factors for development of ampullary tumors. 5 Since the incidence of ampullary tumor is increasing, especially in younger adults, this study is particularly welcome. History of previous cholecystectomy (HR: 2.07) and chronic use of proton pump inhibitor (HR: 1.7) were independently associated with development of ampullary tumors.…”

Updates in endoscopic management of ampullary and duodenal adenomas

“…]. Recent data also suggests that the presence of diabetes, cholelithiasis, and apolipoprotein A contribute to malignant transformation of benign ampullary adenomas [11,12].…”

“…Among patients without FAP, conditions that result in chronic small bowel inflammation (e.g., celiac disease, small bowel Crohn's disease) increase the risk of adenocarcinoma, although studies that specifically address their association with duodenal adenomas are lacking. Zaccari et al [10 ▪ ] conducted a case-control study that included 223 histologically confirmed AAs and 446 controls. Previous cholecystectomy and proton pump inhibitor use were associated with increased risk of AA; aspirin and light alcohol intake were associated with reduced risk [10 ▪ ].…”

“…Zaccari et al [10 ▪ ] conducted a case-control study that included 223 histologically confirmed AAs and 446 controls. Previous cholecystectomy and proton pump inhibitor use were associated with increased risk of AA; aspirin and light alcohol intake were associated with reduced risk [10 ▪ ]. Recent data also suggests that the presence of diabetes, cholelithiasis, and apolipoprotein A contribute to malignant transformation of benign ampullary adenomas [11,12]…”