Efficacy and safety of endoscopic papillectomy and endoscopic submucosal dissection for early-stage duodenal ampullary carcinoma

Abstract

We have been performing endoscopic submucosal dissection using the water-pressure method (WP-ESD) for ampullary tumors with lateral extension of 20mm or more since 2020. However, the treatment outcomes for ampullary carcinoma remain unclear. This study compared the outcomes of endoscopic papillectomy (EP) in 70 patients and WP-ESD in 6 patients with ampullary carcinoma up to T1a (M). The R0 resection rate was 44% in the EP group and 83% in the WP-ESD group, with all WP-ESD patients achieving negative vertical margins. The complication rates were comparable (approximately 16%) and were managed conservatively in all cases. Tumor remission was achieved in 89.6% of cases, while additional surgery was performed in 11% of cases. Endoscopic tumor control (without requiring additional surgery) was achieved in 80% of patients. The 5-year survival rate was 90.6% and none of the patients died from ampullary carcinoma. Endoscopic treatment for early-stage ampullary carcinoma demonstrated excellent outcomes, particularly for WP-ESD, which achieved a high R0 resection rate without increasing the risk of complications. WP-ESD is a valuable treatment option for patients with lateral extensions. Further studies and long-term follow-up are essential to validate its efficacy and safety. WP-ESD is technically challenging, requiring careful patient selection and expert management.