Gut Liver.  2014 Nov;8(6):598-604. 10.5009/gnl14099.

Current Status of Endoscopic Papillectomy for Ampullary Tumors

• Moon JH
• Choi HJ
• Lee YN

• KMID: 2070075
• DOI: http://doi.org/10.5009/gnl14099

Abstract

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.

Keyword

Ampullary tumor; Ampullary adenoma; Endoscopic resection; Endoscopic papillectomy

MeSH Terms

Adenoma/pathology/*surgery
Ampulla of Vater/pathology/*surgery
Carcinoma/pathology/*surgery
Common Bile Duct Neoplasms/pathology/*surgery
Endoscopy, Digestive System
Humans