Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

Vu Trung K, Abou-Ali E, Gulla A, Soares K, Caillol F, Paik WH, Napoleon B, Halimi A, Masaryk V, Bruno MJ, Pérez-Cuadrado-Robles E, Bolm L, Seyfried S, Petrone MC, Yilmaz B, Vollmer C, Berger A, Maggino L, Schemmer P, Wichmann D, Karam E, Dugic A, Kunovsky L, Regner S, Gaujoux S, Hollenbach M (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1016/j.gie.2025.03.1333

Abstract

Background and Aims: Endoscopic papillectomy (EP) is the standard treatment for noninvasive ampullary lesions (ALs), whereas advanced cases require surgery. Managing ALs is challenging and may lead to over- or undertreatment. We developed a score to identify the best candidates for endoscopic or surgical treatment. Methods: We analyzed 447 patients who underwent EP. The cohort was randomly split into a training set (n = 325) and validation set (n = 122). Logistic regression identified predictors for incomplete resection (R1), which were incorporated into a 4-item score. Performance was assessed using the area under the receiver-operating characteristic curve (AUROC). Results: Independent predictors for R1 included size ≥30 mm (S), high-grade dysplasia and/or invasive cancer (D), laterally spreading-lesion (L), and bile or pancreatic duct dilation (D), which we named the SDLD score. ALs with 0 to 1 points had the highest complete resection rates (training, 86.0%; validation, 88.5%), whereas ≥2 points significantly increased R1 rates (training, 52.0%; validation, 57.7%; P < .001). The AUROC was 0.792 (training) and 0.708 (validation). Conclusions: The SDLD score predicts R1 in EP and aids in treatment decisions.

Authors with CRIS profile

Involved external institutions

University of Pennsylvania (UPenn) United States (USA) (US) Centre hospitalier universitaire (CHU) d'Angers France (FR) University of Verona / Università degli Studi di Verona Italy (IT) Karl-Franzens-Universität Graz Austria (AT) Universitätsklinikum Tübingen Germany (DE) CHU de Caen Normandie France (FR) University Hospital Olomouc / Fakultní Nemocnice Olomouc Czech Republic (CZ) Lund University / Lunds universitet Sweden (SE) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Universität Leipzig Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Hôpital Cochin France (FR) Lithuanian University of Health Sciences / Lietuvos sveikatos mokslų universitetas (LSMU) Lithuania (LT) Memorial Sloan Kettering Cancer Center United States (USA) (US) Hôpital Privé Jean Mermoz France (FR) Karolinska Institute Sweden (SE) SRH Wald-Klinikum Gera Germany (DE) Erasmus University Medical Center (MC) Netherlands (NL) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Klinikum rechts der Isar Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Institute Paoli-Calmettes France (FR) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR)

How to cite

APA:

Vu Trung, K., Abou-Ali, E., Gulla, A., Soares, K., Caillol, F., Paik, W.H.,... Hollenbach, M. (2025). Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2025.03.1333

MLA:

Vu Trung, Kien, et al. "Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions." Gastrointestinal Endoscopy (2025).

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