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.
