Endoscopic ampullectomy: A technical review

Abstract

Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

“…Post EA bleeding was seen most often in our cohort (12.6%), with literature data indicating a median risk of 8.5% of cases [29]. Most patients were treated endoscopically, but one patient required coiling of the gastroduodenal artery to control the bleed.…”

Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms

“…2 cm. 12 A p value < 0.05 was considered statistically significant. The SPSS version 24 was used (IBM, SPSS Inc, Illinois, USA).…”

“…20 Risk factors for recurrence following endoscopic snare papillectomy have been largely described. 12 In small tumors with no intraductal extension or endoscopic features of malignancy a 92.6% overall curative resection rate has been reported. 20 Larger tumors are more likely to be incompletely resected or require multiple endoscopic sessions.…”

“…Endoscopic therapy by standard or over-thescope clips to close the perforation was successfully carried out in all cases, with no need of surgery and a satisfactory clinical evolution. The median length of hospitalization in these patients was 7 days (range: [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Robotic transduodenal excision of ampullary tumour

“…Moreover, it carries 15% overall complication rate, including risk of pancreatitis, bleeding, perforation, cholangitis and papillary stenosis. Mortality risk is up to 0.3% and the risk of local recurrence was reported up to 33% (7,8). Therefore, endoscopic ampullectomy may be considered in patients with small (<2 cm) villous or tubulovillous adenoma, adenomyosis, neurinoma and chronic papillitis (9), and in patients who are poor surgical candidates.…”