Endoscopic papillectomy for ampullary lesions of minor papilla

Abstract

Background and AimsAmpullary lesions (AL) 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. MethodsWe identified 20 patients with AL of minor duodenal papilla out of the multicentric database from the ESAP study that included 1422 EPs. We used the propensity score matching (nearest-neighbor method), to match these cases with ampullary lesions of the major duodenal papilla based on age, gender, histologic subtype and size of the lesion in a 1:2-ratio. Cohorts were compared by using Chi-square or Fisher's exact test as well as Mann-Whitney U test. ResultsPropensity-score-based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histological 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 non-neoplastic lesions. Invasive cancer (T1a), adenomyoma and neuroendocrine neoplasia each were found in one case. The rate of complete resection, en bloc resection and recurrences were comparable between both groups. There were no severe complications after EP of lesions of minor papilla. One patient had a delayed bleeding that could be treated by endoscopic hemostasis and two patients showed a recurrence in surveillance endoscopy after a median follow up of 21 months (IQR 12-50). ConclusionsEP is safe and effective in AL of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.