Long‐Term Outcomes Following Endoscopic Papillectomy for Ampullary Neuroendocrine Tumors

Background The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp‐NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long‐term outcomes of EP for Amp‐NETs, focusing on recurrence and procedural safety. Methods Patients with histologically confirmed Amp‐NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size < 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure‐related adverse events, and recurrence‐free survival (RFS). Results Thirty‐four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow‐up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin‐negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding n = 12, pancreatitis n = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment. Conclusion EP is a safe and effective option for small, well‐differentiated Amp‐NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin‐negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.