PDF herunterladen
Endoscopy
DOI: 10.1055/a-2724-3905
Systematic review

Endoscopic papillectomy for ampullary lesions: pooled analysis with meta-regression analysis of outcomes

Authors

  • Marco Spadaccini

    1   Endoscopy unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)

  • Gianluca Franchellucci

    1   Endoscopy unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)

  • Matteo Colombo

    2   Digestive Endoscopy Unit, Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy (Ringgold ID: RIN551905)

  • Cecilia Binda 

    3   Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
    4   Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy (Ringgold ID: RIN161128)

  • Maria Terrin

    5   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Milano, Italy (Ringgold ID: RIN551905)

  • Giacomo Marcozzi

    1   Endoscopy unit, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)

  • Valeria Poletti 

    6   Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy (Ringgold ID: RIN551905)

  • Marta Andreozzi

    7   Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)

  • Alessandro De Marco

    8   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Milano, Italy (Ringgold ID: RIN9268)

  • Roberto De Sire 

    9   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
    10   Gastroenterology, IBD Unit, Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Italy (Ringgold ID: RIN9307)

  • Daryl Ramai

    11   Internal Medicine, Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)

  • Silvia Carrara

    12   Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Italy

  • Cesare Hassan 

    13   Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)
    14   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy

  • Benedetto Mangiavillano

    15   , Gastrointestinal Endoscopy Unit, Humanitas - Mater Domini, Castellanza (VA), IT, Italy

  • Alessandro Fugazza 

    16   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy

  • Amrita Sethi

    17   Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States (Ringgold ID: RIN21611)

  • Carlo Fabbri

    18   Digestive Endoscopy and Gastroenterology Unit, Forlì-Cesena Hospitals, Azienda Unita Sanitaria Locale della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)

  • Antonio Facciorusso 

    19   Department Experimental Medicine, Università del Salento, Lecce, Italy (Ringgold ID: RIN18976)

  • Andrea Anderloni 

    20   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy

  • Alessandro Repici

    21   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)
    9   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
Weitere Informationen
Auch verfügbar auf
 als PDF herunterladen
Preview

Background: Endoscopic papillectomy(EP)is a viable treatment option for ampullary lesions(AL).While many studies have reported low morbidity and acceptable outcomes, early attempts to pool data from these initial experiences have produced conflicting conclusions regarding key technical aspects. To address these uncertainties, we conducted a systematic review and pooled analysis to evaluate the safety and effectiveness of EP for AL,identifying factors that may influence outcomes. Methods: Electronic databases(Medline, Scopus and EMBASE)were searched up to September 2024. Studies that included patients with endoscopically resected AL were eligible. Effectiveness and safety outcomes were pooled by means of a random-effects model to obtain a proportion with a 95% confidence interval(CI). Subgroup analysis, and univariable meta-regression analyses were conducted to explore potential factors affecting outcomes. Results: A total of 61 studies(4,935 lesions)published between 2002 and 2024 were analyzed. Complete resection was achieved in 85.9%of cases, though intraductal involvement limited success. The recurrence rate was 15.2%, however, the majority(92.4%)of patients were managed endoscopically without surgery. The pooled adverse event(AE)rate was 30.0%, with bleeding(12.8%)and post-procedural pancreatitis(11.2%)being the most common complications. Prophylactic stenting reduced pancreatitis risk, while intraductal involvement increased perforation risk.Adjunctive treatments for intraductal involvement posed an increased risk of papillary stricture. Conclusion: Endoscopic papillectomy is a safe and effective treatment for ampullary lesions. However, lesions with intraductal extension pose a higher risk of incomplete resection and perforation, warranting careful evaluation of the benefit-risk balance in these cases.While prophylactic pancreatic stenting may reduce the incidence of post-procedural pancreatitis, optimizing strategies to minimize overall adverse events remains a key focus for future research.



Publikationsverlauf

Eingereicht: 05. April 2025

Angenommen nach Revision: 15. Oktober 2025

Accepted Manuscript online:
15. Oktober 2025

© . Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany