ampullary adenomaA 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.
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.