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SHR Neuro Cancer Cardio Lipid Metab Microb

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.
Endoscopic papillectomy for laterally spreading lesions of the papilla - a propensity score matched analysis.
Endoscopy. 2025; Doi: 10.1055/a-2641-0614
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Co-authors Med Uni Graz

Schemmer Peter

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Abstract:

BACKGROUND AND AIMS: Endoscopic papillectomy (EP) is a standard treatment for ampullary lesions (AL), typically small and confined to the papillary mound. Laterally spreading lesions (LSL) of the papilla Vateri are a rare AL subtype involving extensive duodenal mucosa. Data on EP outcomes for LSL are limited. This study compared EP for LSL and non-LSL AL in matched cohorts. METHODS: The ESAP study encompassed 1422 endoscopic papillectomies (EPs). Propensity-score matching used the nearest-neighbor method for age, gender, comorbidity, 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 (116 non-LSL, 116 LSL AL) with comparable baseline characteristics. After first intervention, the R0-rate 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% [95%CI 29.2-53.6] vs. 15.0% [95%CI 29.2-53.6]) and lower one- and three-year disease-free survival rates (61.1% [95% CI 42.9-70.9] and 44.0% [95% CI 27.5-59.3] vs. 86.1% [95% CI 74.8-92.6] and 81.6% [95% CI 68.7-89.6]. Complication rates did not differ significantly between the two groups (LSL 32.8% [95% CI 25.0-41.8] vs. non-LSL 26.7% [95% CI 19.4-35.1]). CONCLUSION: LSL can be safely resected by EP, though repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSL necessitates a vigilant surveillance strategy.

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