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Endoscopy
DOI: 10.1055/a-2641-0614
Original article

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

Authors

  • Kien Vu Trung

    1   Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany

  • Einas Abou Ali

    2   Department of Digestive Diseases, Hopital Saint-Antoine, Paris, France (Ringgold ID: RIN37117)

  • Aiste Gulla

    3   Center of Abdominal Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Ringgold ID: RIN58939)

  • Kevin Soares

    4   Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States (Ringgold ID: RIN5803)

  • Fabrice Caillol 

    5   Endoscopic Unit, Paoli Calmettes Institute, Marseille, France

  • Woo Hyun Paik 

    6   Department of Internal Medicine and Liver Research institute, Seoul National University Hospital, Jongno-gu, Korea (the Republic of) (Ringgold ID: RIN58927)
    7   TranslaTUM, Technische Universität München, Munchen, Germany (Ringgold ID: RIN9184)

  • Bertrand Napoleon 

    8   endoscopy unit, Hopital Prive Jean Mermoz Ramsay Sante, Lyon, France

  • Asif Halimi

    9   Department of Surgical and Perioperative Sciences, University Hospital of Umeå, Umea, Sweden (Ringgold ID: RIN59563)

  • Viliam Masaryk

    10   Department of Gastroenterology and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany (Ringgold ID: RIN39597)

  • Marco J. Bruno

    11   Dept. of Gastroenterology & Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands

  • Enrique Pérez-Cuadrado-Robles 

    12   Hepato-gastroenterology, Hôpital Europeen Georges-Pompidou - Broussais, Paris, France (Ringgold ID: RIN55647)

  • Louisa Bolm

    13   Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany

  • Steffen Seyfried

    14   Department of Surgery, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

  • Maria Chiara Petrone

    15   Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientif Institute San Raffaele, Milan, Italy

  • Bengisu Yilmaz

    16   Department of Surgery, , Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany

  • Charles Vollmer

    17   Department of Surgery,, University of Pennsylvania Department of Clinical Studies Philadelphia, Philadelphia, United States (Ringgold ID: RIN204923)

  • Arthur Berger 

    18   Hepatology and Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France (Ringgold ID: RIN26966)

  • Laura Maggino

    19   Department of Surgery and Oncology,, Unit of Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy

  • Peter Schemmer

    20   Department of Surgery, Medical University of Graz, Graz, Austria

  • Dörte Wichmann 

    21   General, Visceral and Transplant Surgery, University hospital Tübingen, Tübingen, Germany

  • Elias Karam

    22   Department of digestive surgery, Centre hospitalo-universitaire de Caen, Caen, France

  • Ana Dugic

    23   Department of Gastroenterology, Medizincampus Oberfranken, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Bayreuth, Germany (Ringgold ID: RIN9171)

  • Sara Regnér

    24   Department of Surgery, Malmö University Hospital, Malmö, Sweden, Department of Clinical Science, Lund University, Malmö, Sweden

  • Sebastien Gaujoux

    25   Digestive Surgery, University Paris 5, Cochin hospital, APHP, Paris, France

  • Marcus Hollenbach 

    26   Department of Gastroenterology, Hepatology, Infectious Diseases, Endocrinology, Heidelberg University, Marburg, Germany (Ringgold ID: RIN9144)

Supported by: German Research Foundation
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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.



Publication History

Received: 11 January 2025

Accepted after revision: 22 June 2025

Accepted Manuscript online:
23 June 2025

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