Related Experiment Video
Updated: Jun 8, 2026
Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Endoscopic submucosal dissection versus endoscopic papillectomy for ampullary tumors with a lesion base ≥20 mm: a
Kazuma Fukuzawa1, Takashi Hirose2, Yoshihisa Takada1
1Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Background And Aims:
Optimal endoscopic management of ampullary tumors with a large base (≥20 mm) remains unclear. We compared the outcomes of endoscopic submucosal dissection (ESD) versus endoscopic papillectomy (EP).
Methods:
This retrospective study included consecutive patients undergoing ESD or EP for ≥20-mm base ampullary tumors (March 2004-April 2026). Inclusion required adenoma or mucosal carcinoma and intraductal extension ≤10 mm. After December 2020, ESD was prioritized for lesions mechanically unsuitable for en bloc snaring. Primary outcomes were en bloc and complete (margin-negative) resection (R0) rates; long-term local control and adverse events (AEs) were also evaluated.
Results:
Seventy-two patients underwent resection (ESD, n = 19; EP, n = 53). Despite larger median tumor sizes (35 vs 23 mm; P < .001), ESD achieved significantly higher en bloc (100% vs 71.7%; P = .007) and R0 (89.5% vs 30.2%; P < .001) resection rates. With ≥1-year follow-up (ESD, n = 17; EP, n = 49), ESD demonstrated superior local control, with 0% residual disease (vs 42.9%; P < .001), 0% recurrence (vs 12.2%; P = .326), and 0% requiring additional endoscopic treatment (vs 44.9%; P < .001). Final clinical remission was 100% versus 87.8%. Despite longer ESD procedure times, overall AE rates were comparable (36.8% vs 22.6%; P = .241).
Conclusions:
For ≥20-mm base ampullary tumors, ESD yields superior resection quality and durable local control compared with EP. Although its technical complexity and procedural risks warrant careful management, ESD serves as a highly effective alternative.