Endoscopic papillectomy for laterally spreading lesions of the papilla : a propensity score-matched analysis
(2026) In Endoscopy 58(1). p.27-36- Abstract
Background Endoscopic papillectomy is a standard treatment for ampullary lesions, which are typically small and confined to the papillary mound. Laterally spreading lesions (LSLs) of the papilla of Vater are a rare ampullary lesion subtype involving extensive duodenal mucosa. Data on endoscopic papillectomy outcomes for LSLs are limited. This study compared endoscopic papillectomy for ampullary LSLs and non-LSLs in matched cohorts. Methods The ESAP study (Endoscopic papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for ampullary neoplasm) encompassed 1422 endoscopic papillectomies. Propensity score matching used the nearest-neighbor method for age, sex, co-morbidity, and histologic subtype as cofactors. The main... (More)
Background Endoscopic papillectomy is a standard treatment for ampullary lesions, which are typically small and confined to the papillary mound. Laterally spreading lesions (LSLs) of the papilla of Vater are a rare ampullary lesion subtype involving extensive duodenal mucosa. Data on endoscopic papillectomy outcomes for LSLs are limited. This study compared endoscopic papillectomy for ampullary LSLs and non-LSLs in matched cohorts. Methods The ESAP study (Endoscopic papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for ampullary neoplasm) encompassed 1422 endoscopic papillectomies. Propensity score matching used the nearest-neighbor method for age, sex, co-morbidity, 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 with ampullary lesions (116 non-LSL, 116 LSL) with comparable baseline characteristics. After first intervention, the R0 resection rate, the primary outcome measure, 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% vs. 15.0%) and lower 1- and 3-year disease-free survival rates (61.1% and 44.0% vs. 86.1% and 81.6%, respectively). Complication rates did not differ significantly between the two groups (LSL 32.8% vs. non-LSL 26.7%). Conclusion LSLs can be safely resected by endoscopic papillectomy, although repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSLs necessitates a vigilant surveillance strategy.
(Less)
- author
- Trung, Kien Vu
; Abou-Ali, Einas
; Gulla, Aiste
; Soares, Kevin
; Caillol, Fabrice
; Paik, Woo H.
; Napoleon, Bertrand
; Halimi, Asif
; Masaryk, Viliam
; Bruno, Marco J.
; Pérez-Cuadrado-Robles, Enrique
; Bolm, Louisa
; Seyfried, Steffen
; Petrone, Maria C.
; Yilmaz, Bengisu
; Vollmer, Charles
; Berger, Arthur
; Maggino, Laura
; Schemmer, Peter
; Wichmann, Dörte
; Karam, Elias
; Dugic, Ana
; Regnér, Sara
LU
; Gaujoux, Sebastien
and Hollenbach, Marcus
(Less) - organization
- publishing date
- 2026-01-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Endoscopy
- volume
- 58
- issue
- 1
- pages
- 10 pages
- publisher
- Georg Thieme Verlag
- external identifiers
-
- pmid:40550486
- scopus:105021235656
- ISSN
- 0013-726X
- DOI
- 10.1055/a-2641-0614
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025. Thieme. All rights reserved.
- id
- a8267d61-c557-4c12-9677-a5574c05f9ff
- date added to LUP
- 2026-01-12 11:42:31
- date last changed
- 2026-02-23 15:29:31
@article{a8267d61-c557-4c12-9677-a5574c05f9ff,
abstract = {{<p>Background Endoscopic papillectomy is a standard treatment for ampullary lesions, which are typically small and confined to the papillary mound. Laterally spreading lesions (LSLs) of the papilla of Vater are a rare ampullary lesion subtype involving extensive duodenal mucosa. Data on endoscopic papillectomy outcomes for LSLs are limited. This study compared endoscopic papillectomy for ampullary LSLs and non-LSLs in matched cohorts. Methods The ESAP study (Endoscopic papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for ampullary neoplasm) encompassed 1422 endoscopic papillectomies. Propensity score matching used the nearest-neighbor method for age, sex, co-morbidity, 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 with ampullary lesions (116 non-LSL, 116 LSL) with comparable baseline characteristics. After first intervention, the R0 resection rate, the primary outcome measure, 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% vs. 15.0%) and lower 1- and 3-year disease-free survival rates (61.1% and 44.0% vs. 86.1% and 81.6%, respectively). Complication rates did not differ significantly between the two groups (LSL 32.8% vs. non-LSL 26.7%). Conclusion LSLs can be safely resected by endoscopic papillectomy, although repeated interventions are necessary to achieve complete resection. The higher risk of recurrence in LSLs necessitates a vigilant surveillance strategy.</p>}},
author = {{Trung, Kien Vu and Abou-Ali, Einas and Gulla, Aiste and Soares, Kevin and Caillol, Fabrice and Paik, Woo H. and Napoleon, Bertrand and Halimi, Asif and Masaryk, Viliam and Bruno, Marco J. and Pérez-Cuadrado-Robles, Enrique and Bolm, Louisa and Seyfried, Steffen and Petrone, Maria C. and Yilmaz, Bengisu and Vollmer, Charles and Berger, Arthur and Maggino, Laura and Schemmer, Peter and Wichmann, Dörte and Karam, Elias and Dugic, Ana and Regnér, Sara and Gaujoux, Sebastien and Hollenbach, Marcus}},
issn = {{0013-726X}},
language = {{eng}},
month = {{01}},
number = {{1}},
pages = {{27--36}},
publisher = {{Georg Thieme Verlag}},
series = {{Endoscopy}},
title = {{Endoscopic papillectomy for laterally spreading lesions of the papilla : a propensity score-matched analysis}},
url = {{http://dx.doi.org/10.1055/a-2641-0614}},
doi = {{10.1055/a-2641-0614}},
volume = {{58}},
year = {{2026}},
}