Ampullary Tumors: Endoscopic Versus Operative Management

Abstract

Most ampullary adenomas (80%) are common benign ampullary tumors; however, they can range from mild dysplasia to high-grade dysplasia to invasive carcinoma. They are considered premalignant lesions found in the setting of familial polyposis syndromes or found sporadically, usually manifested by vague abdominal pain, liver enzyme elevation, jaundice, recurrent pancreatitis, or with uncommon symptoms such as gastrointestinal bleeding or duodenal obstruction. Endoscopic retrograde cholangiopancreatography with biopsy is a minimally invasive technique used to visualize these tumors directly and to evaluate their histologic characteristics. Definitive treatment primarily depends on these histologic results. Local resection has a high rate of recurrence (5% to 30%) and requires postoperative endoscopic surveillance, which is the reason it is not considered as a first choice in the management of ampullary tumors. The operative mortality is 10% or less for pancreaticoduodenectomy, a procedure of choice at most experienced centers for frank carcinoma, foci papillary adenocarcinoma in pre-excisional biopsies, or high-grade dysplasia ampullary adenomas. Endoscopic interventions for presumed benign ampullary adenomas have resolved symptoms of obstruction, but long-term follow up is necessary to detect early malignant transformation. In summary, the choice of treatment depends on level of surgical skill available, patient tolerance of long-term endoscopic surveillance versus radical surgery, and the presence or absence of coexisting familial adenomatous polyposis.

Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos)

“…Surgery carries significant morbidity and a reported mortality rate of as high as 9%. 3,9 Endoscopic treatment may be preferable; however, the limited reports for larger lesions have been small and retrospective, with lesion removal requiring multiple endoscopy sessions. 5,10,11 To date, a description of the technique to resect lesions with substantial extrapapillary extension has not been proffered.…”

Pedunculated Early Ampullary Carcinoma Treated by Ampullectomy: Report of a Case

“…However, endoscopic ampullectomy is difficult for a large tumor such as those more than 4 cm in diameter [8,9]. The significance of this case report is that a large but early pedunculated ampullary carcinoma can be successfully treated by ampullectomy under duodenotomy.…”

“…The treatment of ampullary carcinoma depends on the size and extent of the lesion. Pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy are the procedure of choice for advanced ampullary carcinoma [8]. On the other hand, ampullectomy is established as useful procedure for the diagnosis and treatment of benign and early carcinoma of the ampulla of Vater [4,5].…”

Immunocytochemical Assessment of p53 Protein to Detect Malignancy in Increased Cell-Yield Brush Cytology from the Biliopancreatic Tree

“…Many ampullary adenomas (up to 80%) are common benign ampullary tumors; however, they can range from mild dysplasia to high-grade dysplasia to invasive carcinoma [1]. These neoplasms may be found in the setting of familial polyposis syndromes or sporadically, usually manifested by vague abdominal pain, liver enzyme elevation, jaundice, recurrent pancreatitis, or with uncommon symptoms such as gastrointestinal bleeding or duodenal obstruction [2].…”