Forward- vs. Oblique-Viewing Endoscope for Duodenal Papillectomy: A Comparative Study on Efficacy and Safety.

BACKGROUND AND AIM: Endoscopic papillectomy is an effective approach for selected papillary lesions. However, no consensus on the optimal choice of endoscope for the operation. Here we conducted a comparative study to investigate the effect of forward-viewing endoscopes (FVE) and oblique-viewing endoscopes (OVE) in the efficacy and safety of endoscopic papillectomy. METHODS: Patients who underwent endoscopic papillectomy with OVE and FVE between February 2019 and August 2025 were reviewed retrospectively, regardless of histopathological type. Demographic characteristics, procedure-related results, adverse events, and follow-up outcomes were analyzed. Univariate and multivariate analyses were conducted to identify the risk factors of piecemeal resection and adverse events. RESULTS: A total of 125 patients were included, with 65 patients in the FVE group and 60 patients in the OVE group specifically. Baseline characteristics was comparable between the two groups. The OVE-based papillectomy had a longer procedure time (21 vs. 39 min; p = 0.001), and a higher en bloc resection rate (61.5% vs. 80%; p = 0.024). After adjustment by propensity score matching (PSM), OVE remained associated with a higher en bloc resection rate (P < 0.05). No statistical significance was found in the histopathology, postoperative hospitalization, adverse events and follow-up outcomes. Further logistic regression analysis indicated that submucosal injection was the only risk factor for piecemeal resection, and no statistically significant factor was found to be related to adverse events. CONCLUSIONS: Compared with FVE, OVE tends to yield a higher en bloc resection rate for endoscopic papillectomy, and both modalities demonstrate similar safety outcomes. Submucosal injection was suggested to be a risk factor affecting en bloc resection.