Endoscopic papillectomy of major papilla lesions: Single tertiary care center experience

Endoscopic papillectomy (EP) is an effective endoscopic modality for managing ampullary lesions. This study aimed to evaluate predictors for recurrence and adverse events (AEs) in patients who underwent EP for major papilla lesions.

This was a retrospective analysis of all patients who underwent endoscopic snare papillectomy for a major papilla lesion between January 2006 and December 2021. We assessed multiple patient- and procedure-related variables to identify risk factors related to post-EP AEs and lesion recurrence using both univariate and multivariate analysis. In addition, we compared baseline characteristics and outcomes in patients with familial adenomatous polyposis (FAP) vs. sporadic ampullary lesions (SALs).

Fifty-one patients (11 FAP) were included in the final analysis. Recurrence was seen in 17 patients (37.0%) among those who followed up after technical success. Complete histological (R0) resection was the only factor associated with no recurrence following EP (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.4-20.8, P = 0.014). PEP was associated with delayed bleeding (OR 7.5, 95% CI 1.2-46.1, P = 0.03). In FAP vs. SAL, lesion size was smaller in FAP: 10 mm (interquartile range 6-15 mm) vs. 15 mm (12-21 mm, P = 0.03) and the en-bloc resection rate was higher (100 vs. 67.5%, P = 0.01). Although the recurrence rate was higher in FAP vs. SAL (55.6 vs. 32.4%, P = 0.2), this was not statistically significant. Rates of AEs were similar.

R0 resection was associated with reduced risk of recurrence whereas delayed bleeding after EP is associated with an increased risk of developing PEP. EP is safe and effective for removing ampullary lesions irrespective of lesion type.