Endoscopic Papillectomy for Laterally Spreading Lesions of the Papilla – a matched Analysis

Aims Endoscopic papillectomy (EP) is a standard treatment for ampullary lesions (AL), most of which are small and limited to the papillary mound. Laterally spreading lesions (LSL) of the papilla Vateri represent a rare subtype of AL, characterized by an extensive involvement of the surrounding duodenal mucosa. Data analyzing efficacy and complications of EP for LSL are scarce. In this study, EP for LSL were compared with non-LSL AL in thoroughly matched cohorts.

Methods The ESAP study encompassed 1422 endoscopic papillectomies (EPs). Propensity-score matching using the nearest-neighbor method for age, gender, comorbidity, and histologic subtype as cofactors was performed. The main outcomes were complete resection (R0), technical success, complications, and recurrences.

Results Propensity-score-based matching identified 232 patients (116 non-LSL and 116 LSL AL) with comparable baseline characteristics. LSL sizes were significantly larger compared to non-LSL (median 27.0mm vs. 16.5mm, p<0.001). Therefore, en bloc resection rates were significantly higher in the non-LSL group (71.6% vs. 34.5%, p<0.001). After first intervention, the R0-rate was significantly lower in the LSL group (54.3% vs. 69.0%, p=0.002). Following repeated endoscopic interventions (such as EP, radiofrequency ablation (RFA) or argon plasma coagulation (APC)), the technical success was comparable in both groups (82.8% p=1.00). There were significantly more recurrences in the LSL group (23.8% vs. 8.6%, p=0.013). Complication rates exhibited no significant variance between both groups.

Conclusions LSL can be safely resected by EP, though repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSL necessitates a vigilant surveillance strategy.

Publication History

Article published online:
27 March 2025