New Endoscopic Strategy for Ampullary Tumor and Superficial Nonampullary Duodenal Epithelial Tumor Extending Into Papillary Area

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BACKGROUND AND STUDY AIM: Endoscopic papillectomy (EP) is widely performed for avoiding high-risk surgeries. However, recurrence rates are high, and lateral extension is a risk for recurrence. With endoscopic submucosal dissection (ESD), even lesions with lateral extensions are able to be en bloc resected, and may reduce that risk. The aim of this study is to validate the adequacy and safety of the new strategy. PATIENTS AND METHODS: This is an exploratory observational study with prospective case enrollment and retrospective analysis. INCLUSION CRITERIA: patients aged 20-85 years with a diagnosis of ampullary tumor or superficial nonampullary duodenal epithelial tumors extending into papilla, and endoscopically resected between December 2020 and April 2023. EP was performed with a lateral extension of < 20 mm, and ESD was performed with 20 mm or more, and the validity of these strategies was verified. RESULTS: In total, 40 patients were enrolled, 29 EP and 11 ESD underwent. The en bloc resection rate was 95% (38/40) and endoscopic control was 97.5% (39/40). Adverse events were observed in 27.5% (11/40), with no significant difference in both groups. No serious adverse event was observed. CONCLUSIONS: This strategy based on lateral extension performed very well, and ESD is a useful treatment.