Currently, the three treatment options for ampullary lesions are pancreaticoduodenectomy (Whipple surgery), surgical ampullectomy, and endoscopic papillectomy (EP).
An EUS evaluation of an ampullary lesion prior to a papillectomy attempt was performed, depending on the preference of the endoscopist upon the size and endoscopic appearance of the lesions and/or institutional availability of EUS at the time of the procedure.
Seven patients (17%) had recurrence" six recurrences (85.7%) were diagnosed within the first 6 mo, and one recurrence was diagnosed 1 y after papillectomy. Six of the recurrences were adenomas that were managed endoscopically.
Diagnostic concordance between the prepapillectomy biopsy and papillectomy specimen can be as low as 64% (14).
Cholangiography and pancreatography were performed in all our patients to evaluate proximal duct extension of the ampullary lesions prior to papillectomy attempt.
Post-papillectomy pancreatitis was seen in two patients, one of them had a prophylactic pancreatic duct stent placed during the papillectomy while the other patient did not.
The main limitation of this study was its retrospective nature, lack of predefined algorithm, reliance on data that was not designed for the study, unequal contribution of each institution in terms of number of patients, and a relatively small sample size, as well as reliance on histopathologic results of biopsy samples obtained prior to papillectomy without histopathologic confirmation of the biopsy slides at institutions where papillectomy was performed.
Endoscopic snare papillectomy for tumors of the duodenal papillae.
The need to stage early ACs may increase because of surgical ampullectomy and endoscopic papillectomy. (4,5) We think the current definition of T2--duodenal wall invasion--may lead to misinterpretation of ACs, especially in cases of early AC.
Outcomes of endoscopic papillectomy in elderly patients with ampullary adenoma or early carcinoma.