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Multicenter Study
. 2025 Jul;37(7):749-757.
doi: 10.1111/den.15005. Epub 2025 Mar 21.

Development and validation of a risk score for incomplete resection during endoscopic papillectomy: PANETH score

Cecilia Binda  1 , Antonio Facciorusso  2   3 , Stefano Fabbri  1 , Massimiliano Mutignani  4 , Andrea Tringali  5 , Roberto Di Mitri  6 , Alessandro Fugazza  7 , Romano Sassatelli  8 , Armando Gabbrielli  9   10 , Paolo Giorgio Arcidiacono  11 , Francesco Maria Di Matteo  12 , Chiara Coluccio  1 , Marco Di Marco  13 , Cristiano Spada  5   14 , Alberto Fantin  15 , Claudio De Angelis  16 , Raffaele Macchiarelli  17 , Francesco Perri  18 , Mauro Manno  19 , Luigi Cugia  20 , Alessandro Mussetto  21 , Alessandro Repici  7   22 , Ilaria Tarantino  23 , Andrea Anderloni  24 , Carlo Fabbri  1 ; i‐EUS group
Collaborators, Affiliations
Multicenter Study

Development and validation of a risk score for incomplete resection during endoscopic papillectomy: PANETH score

Cecilia Binda et al. Dig Endosc. 2025 Jul.

Abstract

Objectives: Endoscopic papillectomy (EP) is the gold standard treatment for ampullary adenomas. However, EP is still burdened by a nonnegligible rate of incomplete resections (IR). Different predictors have been linked to higher rates of IR, but the interaction between these factors is still unclear. The aim of the study was to develop a scoring system (hereby called PANETH score) able to quantify the risk of IR after EP.

Methods: Patients who underwent EP in 19 Italian centers in 2016-2021 were included. IR was defined as the presence of residual tumor in lateral or endoampullary margins after EP. Predictors for IR were analyzed by logistic regression and were used to obtain an easy-to-use numeric score. The performance of the model was evaluated with a receiver operating characteristic curve analysis and tested by means of 10-fold cross-validation.

Results: A total of 430 patients were included. On multivariate analysis, laterally spreading tumor (odds ratio [OR] 5.81, 3.21-7.65; P = 0.02), intraductal extension (OR 6.92, 3.33-9.87; P < 0.0001), and bile duct dilation (OR 2.61, 1.22-4.32; P = 0.004) were significant predictors of IR. The score was calculated by the sum of regression coefficients of each predictor. A ≥3 score indicated a 4-fold risk of IR (P < 0.0001). The internal validation resulted in an area under the curve of 0.83 and an overall error rate of 0.11.

Conclusions: The proposed PANETH score may represent a reliable and easily applicable tool to predict the risk of IR after EP to optimize patient selection and risk stratification.

Keywords: endoscopic papillectomy; papillary neoplasm; recurrence; resection.

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