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Published on: October 16, 2013
Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in
Kien Vu Trung1, Einas Abou-Ali2, Aiste Gulla3
1Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany.
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.
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