Endoscopic papillectomy for laterally spreading lesions of the papilla

Endoscopic papillectomy is a recognized treatment for ampullary lesions, including the rare subtype of laterally spreading lesions (LSLs) of the papilla of Vater. LSLs are characterized by their extensive involvement of the duodenal mucosa, making them distinct and more challenging to treat compared to non-LSL ampullary lesions. A recent study compared the outcomes of endoscopic papillectomy for LSLs versus non-LSLs in matched patient cohorts.

The study included 1422 endoscopic papillectomies, with a subset of 232 matched patients (116 LSLs and 116 non-LSLs) based on factors such as age, sex, co-morbidities, and histologic subtype. The primary outcome, complete resection (R0) after the first intervention, was significantly lower in the LSL group (54.3%) compared to the non-LSL group (69.0%). However, after repeated endoscopic interventions, technical success rates were similar for both groups (82.8%).

Despite achieving comparable technical success, LSLs exhibited a significantly higher recurrence rate (41.3%) compared to non-LSLs (15.0%) during a median follow-up of 22 months. Additionally, disease-free survival rates at 1 and 3 years were notably lower in the LSL group (61.1% and 44.0%, respectively) compared to the non-LSL group (86.1% and 81.6%, respectively). Complication rates, however, were not significantly different between the two groups (32.8% for LSLs vs. 26.7% for non-LSLs).

In conclusion, endoscopic papillectomy is a safe and viable option for treating LSLs of the papilla of Vater, but it often requires multiple interventions to achieve complete resection. The higher recurrence rates associated with LSLs highlight the need for vigilant post-procedure surveillance and follow-up care.