Article
Endoscopic papillectomy in Germany: A comprehensive analysis of clinical trends and hospital mortality in Germany
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Authors
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Sven Loosen
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Tobias Essing
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Alexander Mertens
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Sven Loosen
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Christoph Roderburg
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Tom Luedde
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Jennis Kandler
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| Published: | May 30, 2025 |
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Outline
Text
Background: Endoscopic papillectomy (EP) is a minimally invasive procedure for the resection of early ampullary neoplasia. While it is increasingly being adopted as an alternative to surgical resection, the outcomes and complication rates associated with EP vary across different settings and patient populations. However, data on recent clinical developments, as well as a reliable determination of hospital mortality following EP in Germany, remain lacking.
Methods: Clinical trends and hospital mortality of EP in Germany between 2018 and 2022 were analyzed based on standardized hospital discharge data from the Federal Statistical Office of Germany.
Results: A total of 3366 EPs were performed in Germany between 2018 and 2022. The annual number of EPs significantly increased from 557 cases in 2018 to 750 cases in 2022. The median duration of hospitalization was 8.71 days. Hospital mortality was 1.75% and numerically higher in female patients (2.0%) and patients above 70 years (2.2%). Bleeding (16.8%) and post-EP pancreatitis (PEPP, 13.2%) were the most common complications. Among others, the need for mechanical ventilation (42.5%), acute renal failure (21.5%), and biliary/duodenal perforations (17.6/13.5%) were identified as the main factors associated with increased mortality. Prophylactic stenting of the main pancreatic duct (MPD) was not associated with reduced rates of PEPP (13.31 vs. 13.12%) but revealed a non-significant trend towards a lower hospital mortality (1.40 vs. 1.95%, p=0.236).
Conclusion: EP is increasingly performed in Germany. It is a highly effective albeit complex procedure with relatively high procedure related risks and a hospital mortality rate of 1.75%, which is slightly higher than previously described, but still relatively low compared to invasive surgery. However, several complications associated with poor outcomes were identified, which could help improve patient selection and optimize peri- and post-interventional clinical decision-making to further reduce unfavorable outcomes in the future.
