Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Endoscopic papillectomy for ampullary lesions of minor papilla

Vu Trung, Kien ; Heise, Christian ; Abou-Ali, Einas ; Auriemma, Francesco ; Karam, Elias ; van der Wiel, Sophia E. ; Bruno, Marco J. ; Caillol, Fabrice ; Giovannini, Marc and Masaryk, Viliam , et al. (2024) In Gastrointestinal Endoscopy
Abstract

Background and Aims: Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. Methods: We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or... (More)

Background and Aims: Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. Methods: We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or Fisher exact test as well as Mann-Whitney U test. Results: Propensity score–based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en-bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months). Conclusions: EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Gastrointestinal Endoscopy
publisher
Elsevier
external identifiers
  • pmid:37951279
  • scopus:85185597229
ISSN
0016-5107
DOI
10.1016/j.gie.2023.10.040
language
English
LU publication?
yes
id
64e2c356-440b-4fd2-8993-4c8c9ccb27e7
date added to LUP
2024-03-18 14:32:43
date last changed
2024-04-15 11:56:04
@article{64e2c356-440b-4fd2-8993-4c8c9ccb27e7,
  abstract     = {{<p>Background and Aims: Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. Methods: We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or Fisher exact test as well as Mann-Whitney U test. Results: Propensity score–based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en-bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months). Conclusions: EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.</p>}},
  author       = {{Vu Trung, Kien and Heise, Christian and Abou-Ali, Einas and Auriemma, Francesco and Karam, Elias and van der Wiel, Sophia E. and Bruno, Marco J. and Caillol, Fabrice and Giovannini, Marc and Masaryk, Viliam and Will, Uwe and Anderloni, Andrea and Pérez-Cuadrado-Robles, Enrique and Dugic, Ana and Meier, Benjamin and Paik, Woo H. and Petrone, Maria C. and Wichmann, Dörte and Dinis-Ribeiro, Mario and Gonçalves, Tiago C. and Wedi, Edris and Schmidt, Arthur and Gulla, Aiste and Hoffmeister, Albrecht and Rosendahl, Jonas and Ratone, Jean Philippe and Saadeh, Rita and Repici, Alessandro and Deprez, Pierre and Sauvanet, Alain and Souche, Francois R. and Fabre, Jean M. and Muehldorfer, Steffen and Caca, Karel and Löhr, Matthias and Michl, Patrick and Krug, Sebastian and Regner, Sara and Gaujoux, Sebastien and Hollenbach, Marcus}},
  issn         = {{0016-5107}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Gastrointestinal Endoscopy}},
  title        = {{Endoscopic papillectomy for ampullary lesions of minor papilla}},
  url          = {{http://dx.doi.org/10.1016/j.gie.2023.10.040}},
  doi          = {{10.1016/j.gie.2023.10.040}},
  year         = {{2024}},
}