Endoscopic Diagnosis and Management of Ampullary Lesions

Hajj, Ihab I. El; Coté, Gregory A.

doi:10.1016/j.giec.2012.10.004

“…Power output ranges from 30 to 150 W (6,9,13,51,53). Most experts advocate a blended current (54). We use Erbe electrosurgical generators with the setting of Endocut, effect 2 (55).…”

Section: Optimal Electrosurgical Currentmentioning

confidence: 99%

“…Adenoma recurrence has been reported in up to 25% of cases despite presumed complete removal during the index procedure (6,9,54). In the absence of symptoms, surveillance endoscopy can be completed using a side-viewing endoscope (Fig.…”

Section: Endoscopic Follow Up and Surveillancementioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

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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.

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“…Power output oscillates between 30 W and 150 W [6,9,13,73,75] . Most experts, advocate a blended current [76] . We prefer to use Erbe electrosurgical generators (Endocut, effect 2) [77] .…”

Section: Optimal Currentmentioning

confidence: 99%

Endoscopic management of adenomatous ampullary lesions

Espinel¹

2015

WJM

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Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented. Core tip: Adenomatous ampullary lesions are rare. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS) have changed the management of patients with these lesions. Endoscopic ampullectomy is a technique that has revolutionized the treatment of these lesions avoiding potential complications of surgery. We herein discuss the epidemiology, the role of EUS in the local staging and the role of endoscopy in the treatment of the adenomatous ampullary neoplasms.Espinel J, Pinedo E, Ojeda V, Guerra del Rio M. Endoscopic management of adenomatous ampullary lesions. World J REVIEW

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“…If ERCP or prior MRCP have demonstrated a pancreas divisum, pancreatic duct stenting is usually not necessary. Acute cholangitis after endoscopic ampullectomy is infrequent (54), and prophylactic biliary stenting is generally not necessary. However, we often perform either a biliary sphincterotomy or a prophylactic biliary stent is placed to minimize this probability.…”

Section: Sphincterotomy and Stent Placementmentioning

confidence: 99%

“…The overall complication rate is about 15% (4,11,31,48,58). Procedure-related mortality after ampullectomy has been reported but, is very rare, occurring in 0.3% (54).…”

Section: Complications Of Ampullectomymentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

View full text Add to dashboard Cite

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.

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Endoscopic Diagnosis and Management of Ampullary Lesions

Cited by 69 publications

References 52 publications

Endoscopic ampullectomy: A technical review

Endoscopic ampullectomy: A technical review

Endoscopic management of adenomatous ampullary lesions

Endoscopic ampullectomy: A technical review

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