{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:01:38Z","timestamp":1791316898394,"version":"4.3.1"},"reference-count":98,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["Open Access Funding"],"award-info":[{"award-number":["Open Access Funding"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8\u201381.4%, I2 = 91.38%) for EA, 96.4% (93.6\u201399.2%, I2 = 37.8%) for SA and 98.9% (98.0\u201399.7%, I2 = 0%) for PD. AEs were 24.7% (19.8\u201329.6%, I2 = 86.4%), 28.3% (19.0\u201337.7%, I2 = 76.8%) and 44.7% (37.9\u201351.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2\u201315.6%, I2 = 91.3%), 9.4% (4.8\u201314%, I2 = 57.3%) and 14.2% (9.5\u201318.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA\/SA or EA\/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.<\/jats:p>","DOI":"10.3390\/jcm9113622","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T14:10:41Z","timestamp":1605017441000},"page":"3622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions"],"prefix":"10.3390","volume":"9","author":[{"given":"Christian","family":"Heise","sequence":"first","affiliation":[{"name":"Department of Medicine I\u2014Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, 06097 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1997-3262","authenticated-orcid":false,"given":"Einas","family":"Abou Ali","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, 75014 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Hasenclever","sequence":"additional","affiliation":[{"name":"Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Auriemma","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiste","family":"Gulla","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 01513 Vilnius, Lithuania"},{"name":"General Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7505-5880","authenticated-orcid":false,"given":"Sara","family":"Regner","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Section for Surgery, Lund University, 221 00 Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Gaujoux","sequence":"additional","affiliation":[{"name":"Department of Pancreatic and Endocrine Surgery, Piti\u00e9-Salpetriere Hospital, M\u00e9decine Sorbonne Universit\u00e9, 75000 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2654-3164","authenticated-orcid":false,"given":"Marcus","family":"Hollenbach","sequence":"additional","affiliation":[{"name":"Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, 04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3322\/CA.2007.0010","article-title":"Cancer statistics, 2008","volume":"58","author":"Jemal","year":"2008","journal-title":"CA Cancer J. 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