Endoscopy 2022; 54(S 01): S101
DOI: 10.1055/s-0042-1744812
Abstracts | ESGE Days 2022
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ENDOSCOPIC PAPILLECTOMY COMPARED TO SURGERY FOR AMPULLARY LESIONS: A PROPENSITY-SCORE MATCHING ANALYSIS

M. Hollenbach
1   University of Leipzig Medical Center, Division of Gastroenterology, Medical Department II, Leipzig, Germany
,
C. Heise
2   Martin-Luther University Halle-Wittenberg, Medical Department I, Halle, Germany
,
E.A. Ali
3   Paris Descartes University, Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris, France
,
F. Auriemma
4   3 Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milano, Italy
,
A. Gulla
5   Lithuanian University of Health Sciences, Department of Surgery, Kaunas, 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
,
ESA P study group
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Aims Ampullary lesions (AL) can be resected by endoscopic-papillectomy (EP), surgical-ampullectomy (SA) and pancreaticoduodenectomy (PDD). However, consistent data analyzing the different methods are lacking. We compared outcome and complications of EP and surgery in matched patients of a large retrospective multicenter study.

Methods The ESAP study database included 2862 patients. We performed a propensity-score-matching (nearest-neighbor-method) based on age, gender, anthropometrics, co-morbidities, size and histologic subtype of AL. Ampullary carcinoma of T3-/T4-stadium or metastatic diseases were excluded. Main outcomes were complete resection (R0) and complications. Dispersions between EP and PDD or EP and SA were calculated by means of Fisher’s exact or chi-square-test, Mann-Whitney-U-test and log-rank test for survival.

Results Propensity-score-matching identified 151 pairs of patients for EP/PDD and 77 for EP/SA analysis. Baseline characteristics were comparable. Initial R0-rate in the EP/PDD cohort was 84.4% (EP) compared to 100% (PDD, p<0.001). However, anew EP or ablation therapy (APC, RFA) increased R0-rate to 91.3% (p=0.5 compared to PDD). Severe complications were significantly higher in the PDD group (17.2% vs 3.3%, 2 vs. 0 deaths, p<0.001). In the EP/SA group, R0-rate was 87.1% (EP) compared to 90.9% (SA, p=0.4). Complications were not significantly different but SA resulted in 2 deaths (0 in EP). Survival analysis showed a significantly improved long-term survival in EP compared to PDD patients.

Conclusions EP showed a comparable efficacy as surgery for AL and lower risk of complications. Incomplete resections can be treated by repetitive endoscopic therapy. EP should be the standard of care for AL except of advanced invasive cancers.



Publication History

Article published online:
14 April 2022

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