Ampullary neoplastic lesions have the potential for malignant transformation and therefore excision is recommended. This study aimed to evaluate the safety, efficacy, and outcomes of endoscopic papillectomy.

This retrospective study was conducted on patients who underwent endoscopic papillectomy at our center between 2019 and 2025. "Deep papillectomy" was defined as visualization of the pancreatic and bile duct orifices post-resection. Outcomes assessed included rates of en bloc resection, complete resection, pancreatic stenting, and recurrence during follow-up.

A total of 60 patients (mean age 54.5± 15.28 years; of whom 28 , 46.7% female) were included. The median lesion size was 12 mm (range: 6–46 mm). The most common clinical presentation was irregular or enlarged appearing papilla on endoscopic screening in 23 (28.3%) patients. In 53 (88.3%) patients, the lesion was in the major papilla,  4 (6.7%) patients had intraductal extension, and in 3 patients (5%), the lesion was in the minor papilla. Intraductal extension assessment was performed by CT in 27 (45%) patients, by MRCP in 16 (26.7%) patients, and by EUS in 15 (25%) patients. Pre-papillectomy histology revealed isolated low-grade dysplasia without adenoma in 9 (15%) patients, tubular adenoma with low grade dysplasia in 40 (66.7%), tubular adenoma with high-grade dysplasia in 6 (10%), carcinoma in situ in 1 (1.7%), normal tissue in 3 (5%), and no biopsy in 1 (1.7%). In 8 (13.3%) patients, the lesion was excised after submucosal diluted adrenaline injection, while in 52 (86.7%) patients, excision was performed without injection. Pathology results of resection specimens showed tubular adenoma with low grade dysplasia in 30 (50%) patients, adenocarcinoma in 7 (11.7%), and chronic inflammation in 10 (16.7%). En bloc resection was achieved in 47 (78.3%) patients, while 13 (21.7%) underwent piecemeal resection. Complete resection was achieved in 49 (81.7%) cases. Deep resection enabled visualization of both pancreatic and biliary orifices, resulting in a pancreatic stenting rate of 88.3%. Recurrence occurred in 5 patients (8.3%), with a median time to recurrence of 12 months (range: 6–24 months). Post-procedural complications included pancreatitis (8.3%), bleeding (10%), and perforation (3.3%).

 Endoscopic papillectomy is a safe and effective treatment for ampullary neoplastic lesions. Deep resection may enhance complete resection rates and facilitate pancreatic cannulation.