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

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 ou...

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Main Authors: Vu Trung, Kien (Author) , Abou-Ali, Einas (Author) , Gulla, Aiste (Author) , Soares, Kevin (Author) , Caillol, Fabrice (Author) , Paik, Woo H. (Author) , Napoleon, Bertrand (Author) , Halimi, Asif (Author) , Masaryk, Viliam (Author) , Bruno, Marco J. (Author) , Pérez-Cuadrado-Robles, Enrique (Author) , Bolm, Louisa (Author) , Seyfried, Steffen (Author) , Petrone, Maria C. (Author) , Yilmaz, Bengisu (Author) , Vollmer, Charles (Author) , Berger, Arthur (Author) , Maggino, Laura (Author) , Schemmer, Peter (Author) , Wichmann, Dörte (Author) , Karam, Elias (Author) , Dugic, Ana (Author) , Regnér, Sara (Author) , Gaujoux, Sebastien (Author) , Hollenbach, Marcus (Author)
Format: Article (Journal)
Language:English
Published: 2025
In: Endoscopy

ISSN:1438-8812
DOI:10.1055/a-2641-0614
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1055/a-2641-0614
Verlag, lizenzpflichtig, Volltext: http://www.thieme-connect.de.ezproxy.medma.uni-heidelberg.de/DOI/DOI?10.1055/a-2641-0614
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Author Notes:Authors: Kien Vu Trung, Einas Abou-Ali, Aiste Gulla, Kevin Soares, Fabrice Caillol, Woo H. Paik, Bertrand Napoleon, Asif Halimi, Viliam Masaryk, Marco J. Bruno, Enrique Pérez-Cuadrado-Robles, Louisa Bolm, Steffen Seyfried, Maria C. Petrone, Bengisu Yilmaz, Charles Vollmer, Arthur Berger, Laura Maggino, Peter Schemmer, Dörte Wichmann, Elias Karam, Ana Dugic, Sara Regnér, Sebastien Gaujoux, Marcus Hollenbach
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Summary: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. 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. 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%). 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.
Item Description:Artikel online veröffentlicht: 06. November 2025
Gesehen am 27.11.2025
Physical Description:Online Resource
ISSN:1438-8812
DOI:10.1055/a-2641-0614

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