Long-term outcomes and recurrence patterns of endoscopic papillectomy for ampullary tumors: a 15-year experience from a large tertiary center in China.

BACKGROUND AND AIMS: Endoscopic papillectomy (EP) is an established treatment for ampullary tumors. This study aimed to analyze recurrence patterns and risk factors in a large cohort with long-term follow-up. METHODS: Patients who underwent EP for ampullary tumors at a large tertiary center from January 2010 to June 2025 were retrospectively reviewed. Cumulative recurrence rates were estimated using Kaplan-Meier analysis, and Gaussian kernel density estimation was employed to explore dynamic recurrence patterns. Cox proportional hazards model was used to identify risk factors for recurrence. Sensitivity analysis was conducted in a subgroup with at least a 5-year follow-up. RESULTS: A total of 262 patients were enrolled, with an endoscopic treatment success rate of 85.1%. Follow-up analysis included 218 patients, and the 1-year, 3-year, and 8-year cumulative recurrence rates were 4.2, 11.5, and 14.1%, respectively. Recurrences occurred predominantly within 2-year post-procedure, peaking at 14.9 months. Carcinoma was independently associated with an increased risk of recurrence (hazard ratios = 3.878, P = 0.025). Cumulative recurrence risk was significantly higher in carcinoma than in low-grade dysplasia. CONCLUSION: We recommend intensified follow-up during the peak recurrence period as a reasonable strategy. Histology-based personalized surveillance is warranted in routine practice.