Endoscopic papillectomy in Germany: a comprehensive analysis of clinical trends and hospital mortality in Germany.

Background: Endoscopic papillectomy (EP) is a minimally invasive alternative to surgical resection for early ampullary neoplasia. While its use is increasing, outcomes and complication rates vary, and reliable data on hospital mortality in Germany remain scarce.

Methods: We analyzed clinical trends and hospital mortality of EP in Germany from 2018 to 2022 using standardized hospital discharge data from the Federal Statistical Office.

Results: Between 2018 and 2022, 3366 EPs were performed in Germany. Annual procedures rose from 557 in 2018 to 750 in 2022. Median hospital stay was 8.71 days. Overall hospital mortality was 1.75%, higher among women (2.0%) and patients >70 years (2.2%). Bleeding (16.8%) and post-EP pancreatitis (PEPP, 13.2%) were the most common complications. Key factors associated with increased mortality included mechanical ventilation (42.5%), acute renal failure (21.5%), and biliary or duodenal perforations (17.6%/13.5%). Stenting of the main pancreatic duct (MPD) did not affect PEPP rates (13.31% vs. 13.12%) but showed a non-significant trend toward lower mortality (1.40% vs. 1.95%, p = 0.236).

Conclusion: EP is increasingly used in Germany and remains a minimally invasive, organ-preserving procedure with a low hospital mortality of 1.75%, slightly higher than previously reported but still favorable compared to surgery. Identified complications may support better patient selection and improve peri- and post-interventional management to reduce risks and enhance outcomes.