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 ?
Outcomes of endoscopic papillectomy in elderly patients with ampullary adenoma or early carcinoma.
The microsatellite instability phenotype is an early event that develops from adenoma of the ampullary region, and only a few ampullary adenomas harbor the KRAS and BRAF mutations.
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.