Endoscopy 2021; 53(S 01): S38
DOI: 10.1055/s-0041-1724347
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Friday, 26 March 2021 10:00 – 10:45 Challenges in management of ampullary duodenal neoplasms Room 5

Endoscopic Papillectomy Vs. Pancreaticoduodenectomy for Ampullary Lesions: a Propensity-Scored Matching Analysis of the ESAP Study

M Hollenbach
1   University of Leipzig Medical Center, Division of Gastroenterology, Medical Department II, Leipzig, Germany
,
C Heise
2   Martin-Luther University Halle-Wittenberg, Department of Medicine I – Gastroenterology, Pulmonology, Halle, Germany
,
E Abou Ali
3   Paris Descartes University, Department of gastroenterology, digestive oncology and endoscopy, Cochin Hospital, Paris, France
,
F Auriemma
4   Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milano, Italy
,
A Gulla
5   Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Department of abdominal surgery, Vilnius, Lithuania
,
S Regner
6   Lund University, Department of Clinical Sciences Malmö, Section for Surgery, Lund, Sweden
,
S Gaujoux
7   Médecine Sorbonne Université, Department of Pancreatic and Endocrine Surgery, Pitié-Salpetriere Hospital, Paris, France
,
ESAP study group › Author Affiliations
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    Aims Ampullary lesions (AL) are a rare condition but may be clinically significant by obstruction, jaundice, bleeding or malignant transformation. Main resection techniques comprise the endoscopic papillectomy (EP), the surgical ampullectomy (SA) and pancreaticoduodenectomy (PD). Since consistent comparative data are lacking, we performed a retrospective multicenter center study (Endoscopic-Papillectomy-versus-Surgical-Ampullectomy-versus-Pancreaticoduodectomy (ESAP)) comparing the most frequent procedures, i.e. EP and PD.

    Methods On 1330 EP and 1095 PD included in the database, we performed a propensity score matching (nearest-neighbor-method) with regard to age, gender, size and histology of the lesion (adenoma, T1- and T2-adenocarcinoma), ASA-score and previous treatment. Main outcomes were proportions of complete resection (R0), complications, recurrence and hospital stay. Dispersions between EP and PD group were calculated by means of chi-square-test, Students’ t-test and Mann-Whitney-U-test.

    Results Propensity-score-matching identified 270 pairs of patients. Baseline characteristics age (EP: 66.9y, PD: 70.4y, p = 0.315), ASA-score (≥3 EP: 85, PD: 87, p = 0.926), histology (non-neoplastic: 29 vs. 27, Adenoma 115 vs. 118, invasive Cancer 114 vs. 134, other: 22 vs. 11, p = 0.114) and previous treatment (EP: 6.3 %, PD: 9.3 %, p = 0.261) were comparable. However, we were not able to perfectly match lesion size (EP: 20.8mm, PD: 26.6 mm, p = 0.009) and gender (male gender: 48.5 % vs. 58.1 %, p = 0.025). Initial R0-rate was only 50 % for EP and 99.3 % for PD (p<0.001). However, in all EP-patients who underwent an EP-retreatment (30 % of R1 patients), a final R0 was achieved. Complications were significantly higher in PD (≥ moderate: 18.9 % vs. 58.9 %, 0 vs. 9 deaths, p < 0.001) and PD-group revealed a significant longer hospital stay (7.0 vs. 24.5 d, p < 0.001). EP-group showed a higher rate of recurrences (29.6 % vs. 11.1 %, p < 0.001).

    Conclusions In this propensity-score-matched analysis of the largest AL-cohort so far, EP was associated with less complications and a lower initial R0-rate. In most cases, EA-retreatment finally resulted in complete resection.

    Citation: Hollenbach M, Heise C, Abou Ali E et al. OP88 ENDOSCOPIC PAPILLECTOMY VS. PANCREATICODUODENECTOMY FOR AMPULLARY LESIONS: A PROPENSITY-SCORED MATCHING ANALYSIS OF THE ESAP STUDY. Endoscopy 2021; 53: S38.


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    Publication History

    Article published online:
    19 March 2021

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