Efficacy and safety of endoscopic submucosal dissection versus endoscopic papillectomy for managing laterally spreading duodenal papillary tumors

Endoscopic submucosal dissection (ESD) can be performed to treat laterally spreading duodenal papillary tumors (LSPTs). However, no studies have been conducted on the outcomes of ESDs for LSPTs. We retrospectively compared 47 patients who underwent endoscopic papillectomies (EPs) for papillary tumors (PTs) between June 2007 and July 2023 (EP group) and eight patients who underwent ESDs for LSPTs between February 2022 and July 2023 (ESD group). In the subgroup analysis, five patients who underwent EPs for LSPTs were compared with eight patients who underwent ESDs for LSPTs. Procedure times and tumor diameters were significantly greater in the ESD group than in the EP group. The positive or unclear vertical margin (VM1/X) rate was significantly higher in the ESD group. Additional therapies were administered for patients with VM1/X in the ESD group, and no local recurrence was observed. No delayed adverse events occurred in the ESD group; however, delayed bleeding and perforation occurred in the EP group. In the subgroup analysis, the en bloc resection rate was significantly higher in the ESD group than in the EP group. The VM1/X rate did not differ significantly between groups. We suggest that ESD is both feasible and safe for LSPTs.