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

Kien Vu Trung; Einas Abou Ali; Aiste Gulla; Kevin Soares; Fabrice Caillol; Woo Hyun Paik; Bertrand Napoleon; Asif Halimi; Viliam Masaryk; Marco J. Bruno; Enrique Pérez-Cuadrado-Robles; Louisa Bolm; Steffen Seyfried; Maria Chiara Petrone; Bengisu Yilmaz; Charles Vollmer; Arthur Berger; Laura Maggino; Peter Schemmer; Dörte Wichmann; Elias Karam; Ana Dugic; Sara Regnér; Sebastien Gaujoux; Marcus Hollenbach

doi:10.1055/a-2641-0614

Endoscopy, Inhaltsverzeichnis

Endoscopy
DOI: 10.1055/a-2641-0614

Original article

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

Kien Vu Trung

¹Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany

,

Einas Abou Ali

²Department of Digestive Diseases, Hopital Saint-Antoine, Paris, France (Ringgold ID: RIN37117)

,

Aiste Gulla

³Center of Abdominal Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Ringgold ID: RIN58939)

,

Kevin Soares

⁴Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States (Ringgold ID: RIN5803)

,

Fabrice Caillol

⁵Endoscopic Unit, Paoli Calmettes Institute, Marseille, France

,

Woo Hyun Paik

⁶Department of Internal Medicine and Liver Research institute, Seoul National University Hospital, Jongno-gu, Korea (the Republic of) (Ringgold ID: RIN58927)

⁷TranslaTUM, Technische Universität München, Munchen, Germany (Ringgold ID: RIN9184)

,

Bertrand Napoleon

⁸endoscopy unit, Hopital Prive Jean Mermoz Ramsay Sante, Lyon, France

,

Asif Halimi

⁹Department of Surgical and Perioperative Sciences, University Hospital of Umeå, Umea, Sweden (Ringgold ID: RIN59563)

,

Viliam Masaryk

¹⁰Department of Gastroenterology and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany (Ringgold ID: RIN39597)

,

Marco J. Bruno

¹¹Dept. of Gastroenterology & Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands

,

Enrique Pérez-Cuadrado-Robles

¹²Hepato-gastroenterology, Hôpital Europeen Georges-Pompidou - Broussais, Paris, France (Ringgold ID: RIN55647)

,

Louisa Bolm

¹³Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany

,

Steffen Seyfried

¹⁴Department of Surgery, University Medical Centre Mannheim, Mannheim, Germany (Ringgold ID: RIN36642)

,

Maria Chiara Petrone

¹⁵Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University - Scientif Institute San Raffaele, Milan, Italy

,

Bengisu Yilmaz

¹⁶Department of Surgery, , Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany

,

Charles Vollmer

¹⁷Department of Surgery,, University of Pennsylvania Department of Clinical Studies Philadelphia, Philadelphia, United States (Ringgold ID: RIN204923)

,

Arthur Berger

¹⁸Hepatology and Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France (Ringgold ID: RIN26966)

,

Laura Maggino

¹⁹Department of Surgery and Oncology,, Unit of Surgery B, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy

,

Peter Schemmer

²⁰Department of Surgery, Medical University of Graz, Graz, Austria

,

Dörte Wichmann

²¹General, Visceral and Transplant Surgery, University hospital Tübingen, Tübingen, Germany

,

Elias Karam

²²Department of digestive surgery, Centre hospitalo-universitaire de Caen, Caen, France

,

Ana Dugic

²³Department of Gastroenterology, Medizincampus Oberfranken, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Bayreuth, Germany (Ringgold ID: RIN9171)

,

Sara Regnér

²⁴Department of Surgery, Malmö University Hospital, Malmö, Sweden, Department of Clinical Science, Lund University, Malmö, Sweden

,

Sebastien Gaujoux

²⁵Digestive Surgery, University Paris 5, Cochin hospital, APHP, Paris, France

,

Marcus Hollenbach

²⁶Department of Gastroenterology, Hepatology, Infectious Diseases, Endocrinology, Heidelberg University, Marburg, Germany (Ringgold ID: RIN9144)

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Abstract

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Background and aims: Endoscopic papillectomy (EP) is a standard treatment for ampullary lesions (AL), typically small and confined to the papillary mound. Laterally spreading lesions (LSL) of the papilla Vateri are a rare AL subtype involving extensive duodenal mucosa. Data on EP outcomes for LSL are limited. This study compared EP for LSL and non-LSL AL in 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, 116 LSL AL) with comparable baseline characteristics. After first intervention, the R0-rate 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% [95%CI 29.2–53.6] vs. 15.0% [95%CI 29.2–53.6]) and lower one- and three-year disease-free survival rates (61.1% [95% CI 42.9–70.9] and 44.0% [95% CI 27.5–59.3] vs. 86.1% [95% CI 74.8–92.6] and 81.6% [95% CI 68.7–89.6]. Complication rates did not differ significantly between the two groups (LSL 32.8% [95% CI 25.0–41.8] vs. non-LSL 26.7% [95% CI 19.4–35.1]). 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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