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In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Percutaneous choledochoscopy can be used routinely, provided that strict techniques are adhered to. This procedure should be reserved for only a small subset of biliary diseases.

Long-term follow-up revealed no case of advanced ampullary cancer and suggested that endoscopic treatment was satisfactory for the large majority of patients with ampullary adenomas.