Z Gastroenterol 2025; 63(08): e617
DOI: 10.1055/s-0045-1811100
Abstracts | DGVS/DGAV
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Gallenwegsmanagement: Kühler Kopf in engen Röhren Freitag, 19. September 2025, 16:10 – 17:22, Seminarraum 6 + 7

Endoscopic papillectomy for laterally spreading lesions of the papilla – a propensitiy score matched analysis

Authors

  • K Vu Trung

    1   Universitätsklinikum Leipzig, Klinik für Onkologie, Gastroenterologie, Pneumologie, Leipzig, Deutschland

  • C Heise

    2   Heidelberg Universität, Klinik für Innere Medizin IV, Gastroenterologie, Infektiologie, Gastrointestinale Onkologie, Heidelberg, Deutschland

  • E Abou Ali

    3   Cochin Hospital, Paris Descartes University Paris, Department of gastroenterology, digestive oncology and endoscopy, Paris, Frankreich

  • A Gulla

    4   Lithuanian University of Health Sciences, Santaros Klinikos, Department of Surgery, Kaunas, Litauen

  • F Auriemma

    5   Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Mailand, Italien

  • S Regner

    6   Lund University, Department of Clinical Sciences Malmö, Section for Surgery, Lund, Schweden

  • S Gaujoux

    7   Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Department of Digestive and HBP Surgery, Paris, Frankreich

  • M Hollenbach

    8   Universitätsklinikum Gießen und Marburg UKGM, Standort Marburg, Klinik für Gastroenterologie, Endokrinologie, Stoffwechselerkrankungen, Infektiologie, Marburg, Deutschland
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    Background and 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 used the nearest-neighbor method for age, gender, comorbidity, 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 (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). 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% vs 82.8%; p=1.00). After a median FU of 22 months, there were significantly more recurrences in the LSL group (41.3% vs. 15.0%, p<0.001). Complication rates did not differ significantly between the two groups (p=0.756).

    Conclusion: 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.


     

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    Artikel online veröffentlicht:
    04. September 2025

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