Endoscopic papillectomy for laterally spreading lesions of the papilla: a propensity score-matched analysis

Abstract

Background

Endoscopic papillectomy is a standard treatment for ampullary lesions, which are typically small and confined to the papillary mound. Laterally spreading lesions (LSLs) of the papilla of Vater are a rare ampullary lesion subtype involving extensive duodenal mucosa. Data on endoscopic papillectomy outcomes for LSLs are limited. This study compared endoscopic papillectomy for ampullary LSLs and non-LSLs in matched cohorts.

Methods

The ESAP study (Endoscopic papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for ampullary neoplasm) encompassed 1422 endoscopic papillectomies. Propensity score matching used the nearest-neighbor method for age, sex, co-morbidity, and histologic subtype as cofactors. The main outcomes were complete resection (R0), technical success, complications, and recurrences.

Results

Propensity score-based matching identified 232 patients with ampullary lesions (116 non-LSL, 116 LSL) with comparable baseline characteristics. After first intervention, the R0 resection rate, the primary outcome measure, was significantly lower in the LSL group (54.3% [95%CI 45.3%–63.1%]) vs. 69.0% [95%CI 60.4%–76.6%]). Following repeated endoscopic interventions, technical success was similar in both groups (82.8%). After a 22-month median follow-up, the LSL group had significantly more recurrences (41.3% vs. 15.0%) and lower 1- and 3-year disease-free survival rates (61.1% and 44.0% vs. 86.1% and 81.6%, respectively). Complication rates did not differ significantly between the two groups (LSL 32.8% vs. non-LSL 26.7%).

Conclusion

LSLs can be safely resected by endoscopic papillectomy, although repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSLs necessitates a vigilant surveillance strategy.

Publikationsverlauf

Eingereicht: 11. Januar 2025

Angenommen nach Revision: 22. Juni 2025

Accepted Manuscript online:
23. Juni 2025

Artikel online veröffentlicht:
06. November 2025

• References

• 1 Grobmyer SR, Staski CN, Draganov P. et al. Contemporary results with ampullectomy for 29 "benign" neoplasms of the ampulla. J Am Coll Surg 2008; 206: 466-471
• 2 Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004; 11: 301-309
• 3 Li SL, li W, Yin J. et al. Endoscopic papillectomy for ampullary adenomatous lesions: A literature review. World J Gastrointest Oncol 2021; 13: 1466-1474
• 4 Vanbiervliet G, Strijker M, Arvanitakis M. et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 429-448
• 5 Itoi T, Ryozawa S, Katanuma A. et al. Clinical practice guidelines for endoscopic papillectomy. Dig Endosc 2022; 34: 394-411
• 6 Lee H, Park JY, Kwon W. et al. Transduodenal ampullectomy for the treatment of early-stage ampulla of Vater cancer. World J Surg 2016; 40: 967-973
• 7 Hong S, Song KB, Lee Y-J. et al. Transduodenal ampullectomy for ampullary tumors - single center experience of consecutive 26 patients. Ann Surg Treat Res 2018; 95: 22-28
• 8 Song J, Liu H, Li Z. et al. Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy. BMC Surg 2015; 15: 32
• 9 Hopper AD, Bourke MJ, Williams SJ. et al. Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos). Gastrointest Endosc 2010; 71: 967-975
• 10 Gupta S, Craciun A, Wang H. et al. Hybrid resection versus conventional resection for laterally spreading lesions of the papilla. Gastrointest Endosc 2024; 99: 428-436
• 11 Hollenbach M, Abou Ali E, Auriemma F. et al. Study protocol of the ESAP study: endoscopic papillectomy vs. surgical ampullectomy vs. pancreaticoduodenectomy for ampullary neoplasm-A Pancreas2000/EPC Study. Front Med (Lausanne) 2020; 7: 152
• 12 Vu Trung K, Heise C, Abou-Ali E. et al. Endoscopic papillectomy for ampullary lesions of minor papilla. Gastrointest Endosc 2024; 99: 587-595.e1
• 13 Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
• 14 Hollenbach M, Heise C, Abou-Ali E. et al. Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis. Gut 2025; 74: 397-409
• 15 Vandenbroucke JP, von Elm E, Altman DG. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297
• 16 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993; 25: 455-461
• 17 Klein A, Qi Z, Bahin FF. et al. Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent. Endoscopy 2018; 50: 972-983
• 18 Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28: 3083-3107
• 19 De Palma GD. Endoscopic papillectomy: indications, techniques, and results. World J Gastroenterol 2014; 20: 1537-1543
• 20 Napoleon B, Gincul R, Ponchon T. et al. Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study. Endoscopy 2014; 46: 127-134
• 21 Li S, Wang Z, Cai F. et al. New experience of endoscopic papillectomy for ampullary neoplasms. Surg Endosc 2019; 33: 612-619
• 22 Alvarez-Sanchez MV, Oria I, Luna OB. et al. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?. Surg Endosc 2017; 31: 1564-1572
• 23 Sakai A, Tsujimae M, Masuda A. et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol 2019; 25: 1387-1397
• 24 Kang SH, Kim KH, Kim TN. et al. Therapeutic outcomes of endoscopic papillectomy for ampullary neoplasms: retrospective analysis of a multicenter study. BMC Gastroenterol 2017; 17: 69
• 25 Cecinato P, Parmeggiani F, Braglia L. et al. Endoscopic papillectomy for ampullary adenomas: different outcomes in sporadic tumors and those associated with familial adenomatous polyposis. J Gastrointest Surg 2021; 25: 457-466
• 26 Catalano MF, Parmeggiani F, Braglia L. et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59: 225-232
• 27 Choi SJ, Lee HS, Kim J. et al. Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study. World J Gastroenterol 2022; 28: 1845-1859
• 28 Spadaccini M, Fugazza A, Frazzoni L. et al. Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis. United European Gastroenterol J 2020; 8: 44-51
• 29 Heise C, Abou Ali E, Hasenclever D. et al. Systematic review with meta-analysis: endoscopic and surgical resection for ampullary lesions. J Clin Med 2020; 9: 3622
• 30 Gondran H, Musquer N, Perez-Cuadrado-Robles E. et al. Efficacy and safety of endoscopic papillectomy: a multicenter, retrospective, cohort study on 227 patients. Therap Adv Gastroenterol 2022; 15: 17562848221090820
• 31 Sahar N, Krishnamoorthi R, Kozarek RA. et al. Long-term outcomes of endoscopic papillectomy for ampullary adenomas. Dig Dis Sci 2020; 65: 260-268
• 32 van der Wiel SE, Poley J-W, Koch AD. et al. Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study. Surg Endosc 2019; 33: 1180-1188
• 33 Chung KH, Lee SH, Choi JH. et al. Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity-score matching analysis. United European Gastroenterol J 2018; 6: 576-585
• 34 Hyun JJ, Lee TH, Park J-S. et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc 2017; 85: 746-755