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

Marco Spadaccini; Gianluca Franchellucci; Matteo Colombo; Cecilia Binda; Maria Terrin; Giacomo Marcozzi; Valeria Poletti; Marta Andreozzi; Alessandro De Marco; Roberto De Sire; Daryl Ramai; Silvia Carrara; Cesare Hassan; Benedetto Mangiavillano; Alessandro Fugazza; Amrita Sethi; Carlo Fabbri; Antonio Facciorusso; Andrea Anderloni; Alessandro Repici

doi:10.1055/a-2724-3905

Endoscopy, Table of Contents

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

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

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

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

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

⁴Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy (Ringgold ID: RIN161128)
Maria Terrin

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

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

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

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

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

⁹Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)

¹⁰Gastroenterology, IBD Unit, Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Italy (Ringgold ID: RIN9307)
Daryl Ramai

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

¹²Digestive Endoscopy, Istituto Clinico Humanitas, Rozzano, Italy
Cesare Hassan

¹³Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)

¹⁴Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
Benedetto Mangiavillano

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

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

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

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

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

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

²¹Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)

⁹Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)

Abstract

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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.

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