Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis

Aims 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 efficacy 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. Efficacy and safety outcomes were pooled by means of a random-effects model to obtain a proportion with a 95% confidence interval (CI). Uni- and multivariable meta-regression analyses were conducted to explore potential factors affecting outcomes.

Results Fifty-nine studies comprising 4,889 lesions were included. The complete resection rate was 88.4% (95% CI: 85.4–91.5; I²=95%), with oncologically curative resection achieved in 83.4% (95% CI: 80.1–86.9; I²=95%). Lesion size and advanced histology (HGD, carcinoma) were associated with lower curative resection rates. The overall adverse event (AE) rate was 28.5% (95% CI: 24.3–32.8; I²=92%), with no factors significantly affecting this risk. Post-procedural pancreatitis occurred in 11.4% (95% CI: 9.9–12.9; I²=64%), and prophylactic pancreatic stenting did not reduce its incidence. In contrast, the risk of cholangitis (11.7%; 95% CI: 7.6–15.0; I²=40%) was lower in studies with higher biliary stenting rates.

Conclusions EP is a safe and effective treatment for AL, achieving high rates of complete and curative resection. While biliary stenting may help reduce the risk of post-procedural cholangitis, strategies to mitigate overall AEs remain a priority for future research.

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Artikel online veröffentlicht:
27. März 2025