Factors Predictive of Malignancy and Endoscopic Resectability in Ampullary Neoplasia

Abstract

In ampullary lesions, failure to achieve a cleavage plane with submucosal injection is the strongest predictor of malignancy followed by EUS T stage. Endoscopic treatment of benign ampullary neoplasia is effective; no factor was predictive of successful extirpation.

A Survey of Ampullectomy Practices

“…This corresponds to findings by Brackbill et al [24] where 100% of respondents utilized prophylactic pancreatic stenting when performing ampullectomy. Previously, in some retrospective case series, prophylactic pancreatic stenting was performed only in the setting of delayed pancreatic duct drainage [11,15,16,19] . However, recent findings by Harewood et al [20] showing a markedly reduced rate of pancreatitis in those receiving prophylactic pancreatic stenting.…”

“…In the 2 largest series reporting ampullectomy outcomes, both reported using biliary sphincterotomy at the discretion of the endoscopists, although this was not well defined [18,33] . In other series, authors always performed biliary sphincterotomy in patients undergoing ampullectomy [13][14][15][16]19,20] . However, in a recent "Expert's Corner" on endoscopic ampullectomy, biliary sphincterotomy was not mentioned [32] .…”

“…Auira et al [34] argued against biliary sphincterotomy since it carries the risk of bleeding, may interfere with en bloc resection and has the theoretical risk of seeding malignant cells present within the tumor. Unlike biliary sphincterotomy, the routine use of pancreatic sphincterotomy prior to ampullectomy has been advocated in the literature [14,19,32] . Our respondents utilized pancreatic sphincterotomy less frequently than biliary sphincterotomy prior to ampullectomy.…”

“…Our respondents utilized pancreatic sphincterotomy less frequently than biliary sphincterotomy prior to ampullectomy. However, Desilets et al [14] , Kahaleh et al [19] , and Baillie [32] all preferred pre-ampullectomy pancreatic sphincterotomy. The pancreatic sphincterotomy techniques that Desilets et al [14] described were wireguided, involving sphincterotomies extending into normal duodenal tissue within the limits of safety.…”

“…Endoscopic ampullectomy was first described in the 1980s [8][9][10] . Since then, numerous case and cohort series of ampullectomies, both retrospective and prospective, have been reported [11][12][13][14][15][16][17][18][19] . The first prospective, randomized, controlled trial of the use of prophylactic pancreatic duct stenting for endoscopic ampullectomy was published in 2005 [20] .…”