Comparison of endoscopic papillectomy and pancreatoduodenectomy for high-grade intraepithelial neoplasia of the duodenal papilla: a retrospective cohort study.

AIM: The objective of this study is to compare the clinical outcomes of endoscopic papillectomy (EP) and pancreatoduodenectomy (PD) for high-grade intraepithelial neoplasia of the duodenal papilla (HGIN-DP) and develop a preoperative risk prediction model for pathological upgrading.

METHODS

Retrospective analysis of 92 patients (43 EP vs. 49 PD) treated between 2014 and 2023. Propensity score matching (1:1) balanced baseline characteristics, yielding 62 matched cases. Univariate and multivariate logistic regression analysis identified risk factors for pathological upgrading. A nomogram was developed and validated using patient data.

RESULTS

PD demonstrated superior 5-year overall survival (88.5% vs. 61.2%, P < 0.05) but longer operative time (230.0 vs. 41.0 min), higher blood loss (250.0 vs. 1.0 mL), prolonged hospitalization (27.0 vs. 8.0 days), increased costs (CNY 71,116.0 vs. 25,898.0), and higher delayed gastric emptying rates (35.5% vs. 3.2%) compared to EP. Postoperative pathological upgrading occurred in 51.2% (EP) and 69.4% (PD) of cases. Among them, 29.0% were diagnosed with adenocarcinoma in the EP group and 38.7% in the PD group. Multivariate analysis identified age (OR = 1.11), platelet count (OR = 1.02), and tumor size > 1 cm (OR = 21.79) as risk factors for pathological upgrading. A nomogram incorporating these predictors showed strong discriminative accuracy (AUC = 0.91 training, 0.86 validation).

CONCLUSION

EP offers advantages in recovery and cost, while PD remains preferable for HGIN-DP patients with high-risk features. The validated prediction model aids preoperative risk stratification, guiding personalized treatment decisions.