Endoscopic papillectomy for ampullary lesions of minor papilla

Vu Trung K, Heise C, Abou-Ali E, Auriemma F, Karam E, van der Wiel SE, Bruno MJ, Caillol F, Giovannini M, Masaryk V, Will U, Anderloni A, Pérez-Cuadrado-Robles E, Dugic A, Meier B, Paik WH, Petrone MC, Wichmann D, Dinis-Ribeiro M, Gonçalves TC, Wedi E, Schmidt A, Gulla A, Hoffmeister A, Rosendahl J, Ratone JP, Saadeh R, Repici A, Deprez P, Sauvanet A, Souche FR, Fabre JM, Mühldorfer S, Caca K, Löhr M, Michl P, Krug S, Regner S, Gaujoux S, Hollenbach M (2024)

Publication Type: Journal article

Publication year: 2024

Journal

DOI: 10.1016/j.gie.2023.10.040

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 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.

Authors with CRIS profile

Involved external institutions

SRH Wald-Klinikum Gera Germany (DE) Humanitas Research Hospital / IRCCS Istituto Clinico Humanitas Italy (IT) Assistance Publique-Hôpitaux de Paris (AP-HP) France (FR) Centre Hospitalier Universitaire de Montpellier (CHU/CHRU MTP) France (FR) Karolinska Institute Sweden (SE) Universitätsklinikum Heidelberg Germany (DE) Lund University / Lunds universitet Sweden (SE) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Universität Leipzig Germany (DE) Erasmus University Medical Center (MC) Netherlands (NL) Institute Paoli-Calmettes France (FR) Universitätsklinikum Tübingen Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto) Portugal (PT) Hospital da Senhora da Oliveira Guimarães Portugal (PT) Hôpital Cochin France (FR) Universitätsklinikum Göttingen Germany (DE) Albert-Ludwigs-Universität Freiburg Germany (DE) Lithuanian University of Health Sciences / Lietuvos sveikatos mokslų universitetas (LSMU) Lithuania (LT) Interdisciplinary Research Unit for Cancer Prevention and Treatment (ANTICIPE) / Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers France (FR) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Università Vita-Salute San Raffaele (UniSR) Italy (IT)

How to cite

APA:

Vu Trung, K., Heise, C., Abou-Ali, E., Auriemma, F., Karam, E., van der Wiel, S.E.,... Hollenbach, M. (2024). Endoscopic papillectomy for ampullary lesions of minor papilla. Gastrointestinal Endoscopy. https://dx.doi.org/10.1016/j.gie.2023.10.040

MLA:

Vu Trung, Kien, et al. "Endoscopic papillectomy for ampullary lesions of minor papilla." Gastrointestinal Endoscopy (2024).

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