Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

Kien Vu Trung¹, Einas Abou-Ali², Aiste Gulla³, Kevin Soares⁴, Fabrice Caillol⁵, Woo H Paik⁶, Bertrand Napoleon⁷, Asif Halimi⁸, Viliam Masaryk⁹, Marco J Bruno¹⁰, Enrique Pérez-Cuadrado-Robles¹¹, Louisa Bolm¹², Steffen Seyfried¹³, Maria C Petrone¹⁴, Bengisu Yilmaz¹⁵, Charles Vollmer¹⁶, Arthur Berger¹⁷, Laura Maggino¹⁸, Peter Schemmer¹⁹, Dörte Wichmann²⁰, Elias Karam²¹, Ana Dugic²², Lumir Kunovsky²³, Sara Regner²⁴, Sebastien Gaujoux²⁵, Marcus Hollenbach²⁶; ESAP Study Group

Collaborators, Affiliations

Collaborators

ESAP Study Group:
Christian Heise, Francesco Auriemma, Galen Leung, Mark A Schattner, William R Jarnagin, Tiegong Wang, Marc Giovannini, Jean Philippe Ratone, Alessandro Zerbi, Gennaro Nappo, Urban Arnelo, Erik Haraldsson, Alexander Waldthaler, Uwe Will, Rita Saadeh, Sophia E van der Wiel, Pierre Deprez, Alain Sauvanet, Tobias Keck, Francois R Souche, Jean M Fabre, Nicolas Musquer, Georg Kähler, Alberto Mariani, Piera Zaccari, Giulio Belfiori, Massimo Falconi, Stefano Partelli, Ihsan Ekin Demir, Güralp O Ceyhan, Jean-Marc Regimbeau, Johan Gagniére, Alessandro Repici, Andrea Anderloni, Fabio Casciani, Marco Del Chiaro, Atsushi Oba, Richard Schulick, Roberto Salvia, Ana Laranjo, Diogo Libanio, Madaline Ilie, Johanna Laukkarinen, Albrecht Hoffmeister, Jonas Rosendahl, Brigitte Schumacher, Louise Barbier, Ephrem Salamé, Arnaud Alves, Nicolas Regenet, Steffen Muehldorfer, Stéphanie Truant, Karel Caca, Marcel Tantau, David Birnbaum, Jens Werner, Kestutis Strupas, Edris Wedi, Katrin Salzmann, Matthieu Bruzzi, Renato-Micelli Lupinacci, Patrice David, Lilian Schwarz, Arthur Schmidt, Tullio Piardi, Martin Brunel, Jean-Christoph Vaillant, Charles De Ponthaud, Celine Lejeune, Raffaele Brustia, Rim Cherif, Paul-Noet Dumont, Frederic Prat, Matthias Löhr, Benjamin Meier Bogdan P Miutescu, Rainer Christoph Miksch, Yosuke Inoue, Mario Dinis-Ribeiro, Tobias Kleemann, Vasile Sandru, Reea Ahola, David Albers, Tiago C Gonçalves, Tobias J Weismüller, Dominik Heling, Thilo Hackert, Stefano Crippa Moritz Schiemer, Sohei Satoi, Patrick Michl, Sebastian Krug

Affiliations

¹ Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany.
² Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France.
³ Department of Surgery, Lithuanian University of Health Sciences, Santaros Klinikos, Kaunas, Lithuania; Department of General Surgery, MedStar Georgetown University Hospital, The John Hopkins University, Georgetown, Maryland, USA.
⁴ Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁵ Department of Endoscopy, Institut Paoli Calmettes, Marseille, France.
⁶ Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁷ Hopital Prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France.
⁸ Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden.
⁹ Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany.
¹⁰ Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹¹ Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France; Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹² Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
¹³ Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
¹⁴ Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
¹⁵ Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
¹⁶ Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Angers, Angers, France.
¹⁸ Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
¹⁹ Department of General, Visceral and Transplantation Surgery, University of Graz, Graz, Austria.
²⁰ Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany.
²¹ Department of Digestive Surgery, INSERM U1086 ANTICIPE, Centre Hospitalo-Universitaire de Caen, Caen, France.
²² Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany.
²³ 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute, Brno, Czech Republic.
²⁴ Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden.
²⁵ Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France.
²⁶ Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany; Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Marburg, Germany. Electronic address: marcus.hollenbach@web.de.

PMID: 40449630
DOI: 10.1016/j.gie.2025.03.1333

Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

Kien Vu Trung et al. Gastrointest Endosc. 2025 Oct.

. 2025 Oct;102(4):602-606.

doi: 10.1016/j.gie.2025.03.1333. Epub 2025 May 29.

Authors

Collaborators

ESAP Study Group:
Christian Heise, Francesco Auriemma, Galen Leung, Mark A Schattner, William R Jarnagin, Tiegong Wang, Marc Giovannini, Jean Philippe Ratone, Alessandro Zerbi, Gennaro Nappo, Urban Arnelo, Erik Haraldsson, Alexander Waldthaler, Uwe Will, Rita Saadeh, Sophia E van der Wiel, Pierre Deprez, Alain Sauvanet, Tobias Keck, Francois R Souche, Jean M Fabre, Nicolas Musquer, Georg Kähler, Alberto Mariani, Piera Zaccari, Giulio Belfiori, Massimo Falconi, Stefano Partelli, Ihsan Ekin Demir, Güralp O Ceyhan, Jean-Marc Regimbeau, Johan Gagniére, Alessandro Repici, Andrea Anderloni, Fabio Casciani, Marco Del Chiaro, Atsushi Oba, Richard Schulick, Roberto Salvia, Ana Laranjo, Diogo Libanio, Madaline Ilie, Johanna Laukkarinen, Albrecht Hoffmeister, Jonas Rosendahl, Brigitte Schumacher, Louise Barbier, Ephrem Salamé, Arnaud Alves, Nicolas Regenet, Steffen Muehldorfer, Stéphanie Truant, Karel Caca, Marcel Tantau, David Birnbaum, Jens Werner, Kestutis Strupas, Edris Wedi, Katrin Salzmann, Matthieu Bruzzi, Renato-Micelli Lupinacci, Patrice David, Lilian Schwarz, Arthur Schmidt, Tullio Piardi, Martin Brunel, Jean-Christoph Vaillant, Charles De Ponthaud, Celine Lejeune, Raffaele Brustia, Rim Cherif, Paul-Noet Dumont, Frederic Prat, Matthias Löhr, Benjamin Meier Bogdan P Miutescu, Rainer Christoph Miksch, Yosuke Inoue, Mario Dinis-Ribeiro, Tobias Kleemann, Vasile Sandru, Reea Ahola, David Albers, Tiago C Gonçalves, Tobias J Weismüller, Dominik Heling, Thilo Hackert, Stefano Crippa Moritz Schiemer, Sohei Satoi, Patrick Michl, Sebastian Krug

Affiliations

¹ Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany.
² Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France.
³ Department of Surgery, Lithuanian University of Health Sciences, Santaros Klinikos, Kaunas, Lithuania; Department of General Surgery, MedStar Georgetown University Hospital, The John Hopkins University, Georgetown, Maryland, USA.
⁴ Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁵ Department of Endoscopy, Institut Paoli Calmettes, Marseille, France.
⁶ Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁷ Hopital Prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France.
⁸ Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden.
⁹ Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany.
¹⁰ Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹¹ Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France; Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹² Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
¹³ Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany.
¹⁴ Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
¹⁵ Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
¹⁶ Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Angers, Angers, France.
¹⁸ Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
¹⁹ Department of General, Visceral and Transplantation Surgery, University of Graz, Graz, Austria.
²⁰ Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany.
²¹ Department of Digestive Surgery, INSERM U1086 ANTICIPE, Centre Hospitalo-Universitaire de Caen, Caen, France.
²² Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany.
²³ 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute, Brno, Czech Republic.
²⁴ Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden.
²⁵ Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France.
²⁶ Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany; Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Marburg, Germany. Electronic address: marcus.hollenbach@web.de.

PMID: 40449630
DOI: 10.1016/j.gie.2025.03.1333

Abstract

Background and aims: Endoscopic papillectomy (EP) is the standard treatment for noninvasive ampullary lesions (ALs), whereas advanced cases require surgery. Managing ALs is challenging and may lead to over- or undertreatment. We developed a score to identify the best candidates for endoscopic or surgical treatment.

Methods: We analyzed 447 patients who underwent EP. The cohort was randomly split into a training set (n = 325) and validation set (n = 122). Logistic regression identified predictors for incomplete resection (R1), which were incorporated into a 4-item score. Performance was assessed using the area under the receiver-operating characteristic curve (AUROC).

Results: Independent predictors for R1 included size ≥30 mm (S), high-grade dysplasia and/or invasive cancer (D), laterally spreading-lesion (L), and bile or pancreatic duct dilation (D), which we named the SDLD score. ALs with 0 to 1 points had the highest complete resection rates (training, 86.0%; validation, 88.5%), whereas ≥2 points significantly increased R1 rates (training, 52.0%; validation, 57.7%; P < .001). The AUROC was 0.792 (training) and 0.708 (validation).

Conclusions: The SDLD score predicts R1 in EP and aids in treatment decisions.

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Conflict of interest statement

Disclosure The following author received research support for this study from the German Research Foundation and Universität Leipzig within the program of Open Access Publishing: M. Hollenbach. In addition, the following authors disclosed financial relationships: B. Napoleon: Teacher for Boston Scientific, Olympus, and Mauna Kea Technology. M. J. Bruno: Lecturer for and research support from Boston Scientific. S. Gaujoux: Lecturer for Viatris. M. Hollenbach: Lecturer and expert panel member for Fujifilm. All other authors disclosed no financial relationships. Research support for this study was provided by the Karolinska Institute, the European Pancreatic Club/EPC, and the Acibadem Mehmet Ali Aydinlar University for the ninth Pancreas2000 education and research program to M. Löhr and G. Ceyhan.

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Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

Collaborators

Affiliations

Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous