Endoscopic papillectomy for ampullary adenomatous lesions: A literature review

Abstract

Ampullary adenomatous lesions of the gastrointestinal tract are rare and can be asymptomatic. Therefore, ampullary adenomas with malignant potential require prompt removal, regardless of whether they are adenomatous or carcinomatous lesions. Endoscopic papillectomy is a safe and effective alternative therapy to surgery to treat duodenal papillary lesions in selected patients. Accurate preoperative diagnosis and staging of ampullary adenomatous lesions are critical for predicting prognosis and determining the most appropriate therapeutic approach. Furthermore, the management and prevention of adverse events and endoscopic treatment for remnant or recurrent lesions and surveillance are essential for successful endoscopic management of ampullary adenomatous lesions. This literature review was based on PubMed and MEDLINE and focused on recent advancements in the endoscopic papillectomy technique to provide a comprehensive view of endoscopic papillectomy to treat ampullary adenomatous lesions.

Updates in endoscopic management of ampullary and duodenal adenomas

“…An area of uncertainty is the optimal length and diameter of PD stents. In some studies, longer (>7 cm) and thicker (>5 Fr) stents appeared to reduce incidence of pancreatitis compared to traditionally used prophylactic stents, which are 4-5 Fr in diameter in 5 cm in size [35,36]. Use of endoscopic wire guided papillectomy (placement of a guide wire in the PD prior to EP) reduces the likelihood of unsuccessful PD cannulation after resection.…”

Updates on the Management of Ampullary Neoplastic Lesions

“…Endoscopic papillectomy (EP) refers to the endoscopic resection of the mucosa and submucosa of the duodenal wall, including the region where the ampulla of Vater is anatomically attached, including the excision of the surrounding tissue around the orifices of the bile duct and pancreatic duct [51] (Figure 2). First described in 1983 by Suzuki et al [52], endoscopic papillectomy (EP) has been recognized as an effective treatment for ANLs in selected patients, providing an alternative to traditional surgical methods [53]. Originally, EP was recommended for benign lesions and patients unfit for surgery [53].…”

“…First described in 1983 by Suzuki et al [52], endoscopic papillectomy (EP) has been recognized as an effective treatment for ANLs in selected patients, providing an alternative to traditional surgical methods [53]. Originally, EP was recommended for benign lesions and patients unfit for surgery [53]. However, advancements in endoscopic techniques have broadened its indications to comprise early ampullary carcinoma, giant laterally spreading lesions, and ANLs with intraductal extension [53].…”

Miniprobe ultrasonography guidance during endoscopic submucosal dissection of an ampullary duodenal lesion

“…Endoscopic submucosal dissection (ESD) of ampullary lesions is an alternative to endoscopic papillectomy 1 , which has several drawbacks such as a significant perforation rate, bleeding, and a low curative resection rate 2 3 4 . ESD may overcome these drawbacks, except for the risk of perforation.…”