TY - JOUR
T1 - Development and validation of the SDLD score
T2 - a simplified tool to predict successful endoscopic papillectomy in ampullary lesions
AU - Vu Trung, Kien
AU - Abou-Ali, Einas
AU - Gulla, Aiste
AU - ESAP Study Group
AU - Soares, Kevin
AU - Caillol, Fabrice
AU - Paik, Woo H.
AU - Napoleon, Bertrand
AU - Halimi, Asif
AU - Masaryk, Viliam
AU - Bruno, Marco J.
AU - Pérez-Cuadrado-Robles, Enrique
AU - Bolm, Louisa
AU - Seyfried, Steffen
AU - Petrone, Maria C.
AU - Yilmaz, Bengisu
AU - Vollmer, Charles
AU - Berger, Arthur
AU - Maggino, Laura
AU - Schemmer, Peter
AU - Wichmann, Dörte
AU - Karam, Elias
AU - Dugic, Ana
AU - Kunovsky, Lumir
AU - Regner, Sara
AU - Gaujoux, Sebastien
AU - Hollenbach, Marcus
N1 - Publisher Copyright:
© 2025 American Society for Gastrointestinal Endoscopy
PY - 2025/10
Y1 - 2025/10
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105012834183
U2 - 10.1016/j.gie.2025.03.1333
DO - 10.1016/j.gie.2025.03.1333
M3 - Article
C2 - 40449630
AN - SCOPUS:105012834183
SN - 0016-5107
VL - 102
SP - 602
EP - 606
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 4
ER -
