Development and validation of the SDLD score: a simplified tool to predict successful endoscopic papillectomy in ampullary lesions

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. (Gastrointest Endosc 2025;102:602-6.)