ampullary adenoma

ampullary adenoma

A premalignant tumour that occurs either sporadically or in the setting of familial polyposis syndromes, which follows an adenoma-to-carcinoma sequence similar to colonic adenocarcinoma. Management options include radical surgery, local excision or snare ampullectomy; the optimal management of ampullary adenomas is uncertain.
 
Management
Radical surgery (pancreaticoduodenectomy)
• Pros—Low recurrence rate;
• Cons—Higher morbidity (25–65%) and mortality (0–10%).

Local excision (surgical ampullectomy)
• Pros—Low morbidity (0–25%), no mortality, decreased length of hospital stay;
• Cons—Higher recurrence rates (generally 5–30%), mandatory postoperative endoscopic surveillance.

Snare ampullectomy (endoscopic excision)
• Pros—Low morbidity (12%), low mortality (0–1%), no general anaesthesia;
• Cons—Few experienced operators, procedural complexity sometimes requiring adjunctive modalities such as fulguration, the need for multiple procedures (mean, 2.0 procedures) to effect complete excision with recurrence rates approaching 30%, as well as mandatory ongoing endoscopic surveillance.
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References in periodicals archive ?
In addition, mutations in TP53 tumor suppressor gene have been observed during the progression of ampullary adenomas and low-grade AA to high-grade AA.
Patients with familial adenomatous polyposis (FAP) are at high risk of developing ampullary adenomas that progress to adenocarcinomas.