Gastrointestinal endoscopy · 2026
Endoscopic submucosal dissection versus endoscopic papillectomy for ampullary tumors with a lesion base ≥20 mm: a single-center retrospective comparative study (with videos).
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Fukuzawa Kazuma, Hirose Takashi, Takada Yoshihisa, Furukawa Kazuhiro, Shibata Hiroyuki, Kurata Yoshiyuki, Oshitani Yui, Kumano Ryohei, Iida Tadashi, Mizutani Yasuyuki, Yamao Kentaro, Yamamura Takeshi, Ishikawa Takuya, Kawashima Hiroki
Аннотация
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.
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.