十二指肠小乳头的壶腹病变（AL）极为罕见。内镜乳头切除术 (EP) 是十二指肠大乳头 AL 的常规治疗方法，但 EP 对小 AL 的作用尚未得到准确研究。我们从 ESAP 研究的多中心数据库中确定了 20 名十二指肠小乳头 AL 患者其中包括 1422 张 EP。我们使用倾向评分匹配（最近邻法），根据年龄、性别、组织学亚型和病变大小以1:2的比例将这些病例与十二指肠大乳头壶腹病变进行匹配。使用卡方或 Fisher 精确检验以及 Mann-Whitney U 检验对队列进行比较。基于倾向评分的匹配确定了 60 名具有相似基线特征的患者（小乳头 20 个，大乳头 40 个）的队列。小乳头病变最常见的组织学亚型是 12 名患者的壶腹腺瘤（3 名低度不典型增生，9 名高度不典型增生）。五名患者显示出非肿瘤性病变。浸润性癌（T1a）、腺肌瘤、神经内分泌肿瘤各1例。两组之间的完全切除率、整块切除率和复发率相当。小乳头病变EP术后未出现严重并发症。一名患者出现延迟性出血，可以通过内镜止血治疗，两名患者在中位随访 21 个月 (IQR 12-50) 后监测内镜检查显示复发。EP 对于十二指肠小乳头 AL 是安全有效的。此类病变可根据十二指肠乳头 EP 指南进行处理。版权所有 © 2023 美国胃肠内窥镜协会。由爱思唯尔公司出版。保留所有权利。

Ampullary lesions (AL) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla but the role of EP for minor AL has not been accurately studied.We identified 20 patients with AL of minor duodenal papilla out of the multicentric database from the ESAP study that included 1422 EPs. We used the propensity score matching (nearest-neighbor method), to match these cases with ampullary lesions of the major duodenal papilla based on age, gender, histologic subtype and size of the lesion in a 1:2-ratio. Cohorts were compared by using Chi-square or Fisher's exact test as well as Mann-Whitney U test.Propensity-score-based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histological subtype of lesions of minor papilla was an ampullary adenoma in 12 Patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed non-neoplastic lesions. Invasive cancer (T1a), adenomyoma and neuroendocrine neoplasia each were found in one case. The rate of complete resection, en bloc resection and recurrences were comparable between both groups. There were no severe complications after EP of lesions of minor papilla. One patient had a delayed bleeding that could be treated by endoscopic hemostasis and two patients showed a recurrence in surveillance endoscopy after a median follow up of 21 months (IQR 12-50).EP is safe and effective in AL of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.