Abstract
Background Endoscopic resection of ampullary adenomas is a safe and effective alternative to
surgical resection. A subgroup of patients have large laterally spreading lesions
of the papilla Vateri (LSL-P), which are frequently managed surgically. Data on endoscopic
resection of LSL-P are limited and long-term outcomes are unknown. The aim of this
study was to compare the outcomes of endoscopic resection of LSL-P with those of standard
ampullary adenomas.
Methods A retrospective analysis of a prospectively collected and maintained database was
conducted. LSL-P was defined as extension of the lesion ≥ 10 mm from the edge of the
ampullary mound. Piecemeal endoscopic mucosal resection of the laterally spreading
component was followed by resection of the ampulla. Patient, lesion, and procedural
data, as well as results of endoscopic follow-up, were collected.
Results 125 lesions were resected. Complete endoscopic resection was achieved in 97.6 % at
the index procedure (median lesion size 20 mm, interquartile range [IQR] 13 – 30 mm).
Compared with ampullary adenomas, LSL-Ps were significantly larger (median 35 mm vs.
15 mm), contained a higher rate of advanced pathology (38.6 % vs. 18.5 %), and had
higher rates of intraprocedural bleeding (50 % vs. 24.7 %) and delayed bleeding (25.0 %
vs. 12.3 %). Both groups had similar rates of histologically proven recurrence at
first surveillance (16.4 % vs. 17.9 %). Median follow-up for the entire cohort was
18.5 months. For patients with at least two surveillance endoscopies (n = 68; median
follow-up 29 months, IQR 18 – 48 months), 95.6 % were clear of disease and considered
cured.
Conclusions LSL-P can be resected endoscopically with comparable outcomes to standard ampullectomy,
albeit with a higher risk of bleeding. Endoscopic treatment should be considered as
an alternative to surgical resection, even for large LSL-P.
