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

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. 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. 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]). 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.