Endoscopic papillectomy for ampullary tumors: Multicenter retrospective study

Abstract Although endoscopic papillectomy is an established minimally invasive alternative to surgical resection for ampullary tumors, its technical aspects remain poorly defined. This study aimed to identify factors associated with piecemeal resection and recurrence-free survival after endoscopic papillectomy. A multicenter, retrospective analysis of consecutive patients who underwent endoscopic papillectomy in six tertiary Polish centers between 2011 and 2023 was performed. Multivariable logistic and Cox regression models were applied. A total of 192 patients were included. Adverse events occurred in 26.6% of patients. The most frequent were bleeding (17.3%) and acute pancreatitis (15.6%). En bloc resection was achieved in 66.1% of tumors. Larger tumor size (odds ratio [OR] 1.07 per mm increase; 95% confidence interval [CI] 1.02–1.12]; P = 0.004) and submucosal injection (OR 5.50; 95% CI 1.82–16.68; P = 0.003) were associated with piecemeal resection. Among 142 patients with a median follow-up of 12 months, recurrence occurred in 40.8%. Tumor size (hazard ratio [HR] 1.04 per mm increase; 95% CI 1.03–1.06; P < 0.001) and piecemeal resection (HR 2.37; 95% CI 1.23–4.57; P = 0.010) were independently associated with shorter recurrence-free survival. Larger tumors and piecemeal resection were independently associated with shorter recurrence-free survival. Optimization of technical aspects to achieve higher en bloc resection rates may be critical to reduce recurrence.