Endoscopic papillectomy for laterally spreading lesions of the papilla: a propensity score-matched analysis

Vu Trung K, Abou-Ali E, Gulla A, Soares K, Caillol F, Paik WH, Napoleon B, Halimi A, Masaryk V, Bruno MJ, Pérez-Cuadrado-Robles E, Bolm L, Seyfried S, Petrone MC, Yilmaz B, Vollmer C, Berger A, Maggino L, Schemmer P, Wichmann D, Karam E, Dugic A, Regnér S, Gaujoux S, Hollenbach M (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1055/a-2641-0614

Abstract

Background Endoscopic papillectomy is a standard treatment for ampullary lesions, which are typically small and confined to the papillary mound. Laterally spreading lesions (LSLs) of the papilla of Vater are a rare ampullary lesion subtype involving extensive duodenal mucosa. Data on endoscopic papillectomy outcomes for LSLs are limited. This study compared endoscopic papillectomy for ampullary LSLs and non-LSLs in matched cohorts. Methods The ESAP study (Endoscopic papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for ampullary neoplasm) encompassed 1422 endoscopic papillectomies. Propensity score matching used the nearest-neighbor method for age, sex, co-morbidity, and histologic subtype as cofactors. The main outcomes were complete resection (R0), technical success, complications, and recurrences. Results Propensity score-based matching identified 232 patients with ampullary lesions (116 non-LSL, 116 LSL) with comparable baseline characteristics. After first intervention, the R0 resection rate, the primary outcome measure, was significantly lower in the LSL group (54.3% [95%CI 45.3%-63.1%]) vs. 69.0% [95%CI 60.4%-76.6%]). Following repeated endoscopic interventions, technical success was similar in both groups (82.8%). After a 22-month median follow-up, the LSL group had significantly more recurrences (41.3% vs. 15.0%) and lower 1- and 3-year disease-free survival rates (61.1% and 44.0% vs. 86.1% and 81.6%, respectively). Complication rates did not differ significantly between the two groups (LSL 32.8% vs. non-LSL 26.7%). Conclusion LSLs can be safely resected by endoscopic papillectomy, although repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSLs necessitates a vigilant surveillance strategy.

Authors with CRIS profile

Involved external institutions

Universität Leipzig Germany (DE) Hôpital Cochin France (FR) Lithuanian University of Health Sciences / Lietuvos sveikatos mokslų universitetas (LSMU) Lithuania (LT) Memorial Sloan Kettering Cancer Center United States (USA) (US) Institute Paoli-Calmettes France (FR) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Hôpital Privé Jean Mermoz France (FR) University Hospital of Umeå / Norrlands universitetssjukhus (NUS) Sweden (SE) SRH Wald-Klinikum Gera Germany (DE) Erasmus University Medical Center (MC) Netherlands (NL) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsklinikum Mannheim / University Medical Centre Mannheim (Universitätsmedizin Mannheim) Germany (DE) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Klinikum rechts der Isar Germany (DE) University of Pennsylvania (UPenn) United States (USA) (US) Centre hospitalier universitaire (CHU) d'Angers France (FR) University of Verona / Università degli Studi di Verona Italy (IT) Medizinische Universität Graz Austria (AT) Universitätsklinikum Tübingen Germany (DE) Centre Hospitalier Régional Universitaire de Tours France (FR) Lund University / Lunds universitet Sweden (SE) Sorbonne Université France (FR)

How to cite

APA:

Vu Trung, K., Abou-Ali, E., Gulla, A., Soares, K., Caillol, F., Paik, W.H.,... Hollenbach, M. (2025). Endoscopic papillectomy for laterally spreading lesions of the papilla: a propensity score-matched analysis. Endoscopy. https://doi.org/10.1055/a-2641-0614

MLA:

Vu Trung, Kien, et al. "Endoscopic papillectomy for laterally spreading lesions of the papilla: a propensity score-matched analysis." Endoscopy (2025).

BibTeX: Download