Abstract
Endoscopic ampullectomy has emerged as the primary means for therapeutic management of ampullary adenomas, a precancerous lesion of the duodenal papilla. Appropriate staging of these lesions with increasingly available modalities such as endoscopic ultrasound and endoscopic retrograde cholangiopancreatography can help guide management therapy. While surgery remains the preferred curative procedure for ampullary adenocarcinoma, the role of endoscopy continues to expand and endoscopic resection of lesions displaying high-grade dysplasia and, in selected cases, intraductal involvement continues to be explored. Special consideration is given for adenomas that arise in the setting of familial adenomatous polyposis as this impacts treatment and surveillance decisions. This chapter reviews the role of imaging and endoscopy in the evaluation and treatment of ampullary adenomas. An overview of endoscopic resection techniques and surveillance recommendations is provided.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Brandt LJ. Clinical practice of gastroenterology. Philadelphia: Current Medicine; 1999.
Baczako K, Büchler M, Beger HG, Kirkpatrick CJ, Haferkamp O. Morphogenesis and possible precursor lesions of invasive carcinoma of the papilla of Vater: epithelial dysplasia and adenoma. Hum Pathol. 1985;16(3):305–10.
Yamaguchi K, Enjoji M. Carcinoma of the ampulla of vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer. 1987;59(3):506–15.
Stolte M, Pscherer C. Adenoma-carcinoma sequence in the papilla of Vater. Scand J Gastroenterol. 1996;31(4):376–82.
Fischer HP, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg. 2004;11(5):301–9.
Takashima M, Ueki T, Nagai E, Yao T, Yamaguchi K, Tanaka M, et al. Carcinoma of the ampulla of Vater associated with or without adenoma: a clinicopathologic analysis of 198 cases with reference to p53 and Ki-67 immunohistochemical expressions. Mod Pathol. 2000;13(12):1300–7.
Seifert E, Schulte F, Stolte M. Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. Am J Gastroenterol. 1992;87(1):37–42.
Patel R, Varadarajulu S, Wilcox CM. Endoscopic ampullectomy: techniques and outcomes. J Clin Gastroenterol. 2012;46(1):8–15.
Baker HL, Caldwell DW. Lesions of the ampulla of Vater. Surgery. 1947;21(4):523–31.
Sato T, Konishi K, Kimura H, Maeda K, Yabushita K, Tsuji M, et al. Adenoma and tiny carcinoma in adenoma of the papilla of Vater—p53 and PCNA. Hepatogastroenterology. 1999;46(27):1959–62.
Cheng CL, Sherman S, Fogel EL, McHenry L, Watkins JL, Fukushima T, et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc. 2004;60(5):757–64.
Yao T, Ida M, Ohsato K, Watanabe H, Omae T. Duodenal lesions in familial polyposis of the colon. Gastroenterology. 1977;73(5):1086–92.
Offerhaus GJ, Giardiello FM, Krush AJ, Booker SV, Tersmette AC, Kelley NC, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology. 1992;102(6):1980–2.
Griffioen G, Bus PJ, Vasen HF, Verspaget HW, Lamers CB. Extracolonic manifestations of familial adenomatous polyposis: desmoid tumours, and upper gastrointestinal adenomas and carcinomas. Scand J Gastroenterol Suppl. 1998;225:85–91.
Halsted W. Contributions to the surgery of the bile passages, especially of the common bile duct. Boston Med Surg J. 1899;141:645–54.
Bohra AK, McKie L, Diamond T. Transduodenal excision of ampullary tumours. Ulster Med J. 2002;71(2):121–7.
Di Giorgio A, Alfieri S, Rotondi F, Prete F, Di Miceli D, Ridolfini MP, et al. Pancreatoduodenectomy for tumors of Vater’s ampulla: report on 94 consecutive patients. World J Surg. 2005;29(4):513–8.
Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204(3):356–64.
Suzuki K, Kantou U, Murakami Y. Two cases with ampullary cancer who underwent endoscopic excision. Prog Digest Endosc. 1983;23:236–9.
Han J, Lee SK, Park DH, Choi JS, Lee SS, Seo DW, et al. Treatment outcome after endoscopic papillectomy of tumors of the major duodenal papilla. Korean J Gastroenterol. 2005;46(2):110–9.
Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, et al. Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 1997;225(5):590–9. discussion 599–600.
Guzzardo G, Kleinman MS, Krackov JH, Schwartz SI. Recurrent acute pancreatitis caused by ampullary villous adenoma. J Clin Gastroenterol. 1990;12(2):200–2.
Schwarz M, Pauls S, Sokiranski R, Brambs HJ, Glasbrenner B, Adler G, et al. Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective? Am J Surg. 2001;182(3):243–9.
Elek G, Gyôri S, Tóth B, Pap A. Histological evaluation of preoperative biopsies from ampulla vateri. Pathol Oncol Res. 2003;9(1):32–41.
Blackman E, Nash SV. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study. Hum Pathol. 1985;16(9):901–10.
Grobmyer SR, Stasik CN, Draganov P, Hemming AW, Dixon LR, Vogel SB, et al. Contemporary results with ampullectomy for 29 “benign” neoplasms of the ampulla. J Am Coll Surg. 2008;206(3):466–71.
Menzel J, Hoepffner N, Sulkowski U, Reimer P, Heinecke A, Poremba C, et al. Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT—a prospective, histopathologically controlled study. Gastrointest Endosc. 1999;49(3 Pt 1):349–57.
Ogawa T, Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, et al. Endoscopic papillectomy as a method of total biopsy for possible early ampullary cancer. Dig Endosc. 2012;24(4):291.
Skordilis P, Mouzas IA, Dimoulios PD, Alexandrakis G, Moschandrea J, Kouroumalis E. Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. BMC Surg. 2002;2:1.
Chen CH, Tseng LJ, Yang CC, Yeh YH, Mo LR. The accuracy of endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and transabdominal ultrasound in the detection and staging of primary ampullary tumors. Hepatogastroenterology. 2001;48(42):1750–3.
Cannon ME, Carpenter SL, Elta GH, Nostrant TT, Kochman ML, Ginsberg GG, et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc. 1999;50(1):27–33.
Okano N, Igarashi Y, Hara S, Takuma K, Kamata I, Kishimoto Y, et al. Endosonographic preoperative evaluation for tumors of the ampulla of Vater using endoscopic ultrasonography and intraductal ultrasonography. Clin Endosc. 2014;47(2):174–7.
Artifon EL, Couto D, Sakai P, da Silveira EB. Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest Endosc. 2009;70(2):290–6.
Kubo H, Chijiiwa Y, Akahoshi K, Hamada S, Matsui N, Nawata H. Pre-operative staging of ampullary tumours by endoscopic ultrasound. Br J Radiol. 1999;72(857):443–7.
Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, Takasawa O, et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007;66(4):740–7.
Baillie J. Endoscopic ampullectomy: does pancreatic stent placement make it safer? Gastrointest Endosc. 2005;62(3):371–3.
Chini P, Draganov PV. Diagnosis and management of ampullary adenoma: the expanding role of endoscopy. World J Gastrointest Endosc. 2011;3(12):241–7.
Adler DG, Qureshi W, Davila R, Gan SI, Lichtenstein D, Rajan E, et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc. 2006;64(6):849–54.
Ridtitid W, Schmidt SE, Al-Haddad MA, LeBlanc J, DeWitt JM, McHenry L, et al. Performance characteristics of EUS for locoregional evaluation of ampullary lesions. Gastrointest Endosc. 2015;81(2):380–8.
Gaspar J, Shami VM. The role of EUS in ampullary lesions: is the answer black and white? Gastrointest Endosc. 2015;81(2):389–90.
Hopper AD, Bourke MJ, Williams SJ, Swan MP. Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos). Gastrointest Endosc. 2010;71(6):967–75.
Norton ID, Gostout CJ, Baron TH, Geller A, Petersen BT, Wiersema MJ. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc. 2002;56(2):239–43.
Catalano MF, Linder JD, Chak A, Sivak Jr MV, Raijman I, Geenen JE, et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc. 2004;59(2):225–32.
Kim JH, Moon JH, Choi HJ, Lee HS, Kim HK, Cheon YK, et al. Endoscopic snare papillectomy by using a balloon catheter for an unexposed ampullary adenoma with intraductal extension (with videos). Gastrointest Endosc. 2009;69(7):1404–6.
Bohnacker S, Seitz U, Nguyen D, Thonke F, Seewald S, deWeerth A, et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005;62(4):551–60.
Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc. 1993;39(2):127–31.
Desilets DJ, Dy RM, Ku PM, Hanson BL, Elton E, Mattia A, et al. Endoscopic management of tumors of the major duodenal papilla: refined techniques to improve outcome and avoid complications. Gastrointest Endosc. 2001;54(2):202–8.
Silvis SE. Endoscopic snare papillectomy. Gastrointest Endosc. 1993;39(2):205–7.
El Hajj II, Coté GA. Endoscopic diagnosis and management of ampullary lesions. Gastrointest Endosc Clin N Am. 2013;23(1):95–109.
Eswaran SL, Sanders M, Bernadino KP, Ansari A, Lawrence C, Stefan A, et al. Success and complications of endoscopic removal of giant duodenal and ampullary polyps: a comparative series. Gastrointest Endosc. 2006;64(6):925–32.
Jung MK, Cho CM, Park SY, Jeon SW, Tak WY, Kweon YO, et al. Endoscopic resection of ampullary neoplasms: a single-center experience. Surg Endosc. 2009;23(11):2568–74.
Ito K, Fujita N, Noda Y. Endoscopic diagnosis and treatment of ampullary neoplasm (with video). Dig Endosc. 2011;23(2):113–7.
Small AJ, Baron TH. Successful endoscopic resection of ampullary adenoma with intraductal extension and invasive carcinoma (with video). Gastrointest Endosc. 2006;64(1):148–51.
Fukushima H, Yamamoto H, Nakano H, Nakazawa K, Sunada K, Wada S, et al. Complete en bloc resection of a large ampullary adenoma with a focal adenocarcinoma by using endoscopic submucosal dissection (with video). Gastrointest Endosc. 2009;70(3):592–5.
Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989;2(8666):783–5.
Baron TH. Ampullary adenoma. Curr Treat Options Gastroenterol. 2008;11(2):96–102.
Björk J, Akerbrant H, Iselius L, Bergman A, Engwall Y, Wahlström J, et al. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology. 2001;121(5):1127–35.
Yoon SM, Kim MH, Kim MJ, Jang SJ, Lee TY, Kwon S, et al. Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy? Gastrointest Endosc. 2007;66(4):701–7.
Seewald S, Omar S, Soehendra N. Endoscopic resection of tumors of the ampulla of Vater: how far up and how deep down can we go? Gastrointest Endosc. 2006;63(6):789–91.
Kim JH, Han JH, Yoo BM, Kim MW, Kim WH. Is endoscopic papillectomy safe for ampullary adenomas with high-grade dysplasia? Ann Surg Oncol. 2009;16(9):2547–54.
Pandolfi M, Martino M, Gabbrielli A. Endoscopic treatment of ampullary adenomas. JOP. 2008;9(1):1–8.
Kim MH, Lee SK, Seo DW, Won SY, Lee SS, Min YI. Tumors of the major duodenal papilla. Gastrointest Endosc. 2001;54(5):609–20.
Yamao T, Isomoto H, Kohno S, Mizuta Y, Yamakawa M, Nakao K, et al. Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla. Surg Endosc. 2010;24(1):119–24.
Boix J, Lorenzo-Zúñiga V, Moreno de Vega V, Domènech E, Gassull MA. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc. 2009;23(1):45–9.
Irani S, Arai A, Ayub K, Biehl T, Brandabur JJ, Dorer R, et al. Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period. Gastrointest Endosc. 2009;70(5):923–32.
Wong RF, DiSario JA. Approaches to endoscopic ampullectomy. Curr Opin Gastroenterol. 2004;20(5):460–7.
Ghidirim G, Mişin I, Istrate V, Cazacu S. Endoscopic papillectomy into the treatment of neoplastic lesions of Vater papilla. Curr Health Sci J. 2009;35(2):92–7.
Saurin JC, Chavaillon A, Napoléon B, Descos F, Bory R, Berger F, et al. Long-term follow-up of patients with endoscopic treatment of sporadic adenomas of the papilla of Vater. Endoscopy. 2003;35(5):402–6.
Norton ID, Geller A, Petersen BT, Sorbi D, Gostout CJ. Endoscopic surveillance and ablative therapy for periampullary adenomas. Am J Gastroenterol. 2001;96(1):101–6.
Ceppa EP, Burbridge RA, Rialon KL, Omotosho PA, Emick D, Jowell PS, et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg. 2013;257(2):315–22.
Lienert A, Bagshaw PF. Treatment of duodenal adenomas with endoscopic argon plasma coagulation. ANZ J Surg. 2007;77(5):371–3.
Ghilain JM, Dive C. Endoscopic laser therapy for small villous adenomas of the duodenum. Endoscopy. 1994;26(3):308–10.
Farnell MB, Sakorafas GH, Sarr MG, Rowland CM, Tsiotos GG, Farley DR, et al. Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg. 2000;4(1):13–21. discussion 2–3.
Zádorová Z, Dvofák M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy. 2001;33(4):345–7.
Chacko A, Dutta AK. Endoscopic resection of ampullary adenomas: novel technique to reduce post procedure pancreatitis. J Gastroenterol Hepatol. 2010;25(8):1338–9.
Fazel A, Quadri A, Catalano MF, Meyerson SM, Geenen JE. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003;57(3):291–4.
Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD, Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998;115(6):1518–24.
Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc. 2005;62(3):367–70.
Moon JH, Cha SW, Cho YD, Ryu CB, Cheon YK, Kwon KW, et al. Wire-guided endoscopic snare papillectomy for tumors of the major duodenal papilla. Gastrointest Endosc. 2005;61(3):461–6.
Kubiliun NM, Adams MA, Akshintala VS, Conte ML, Cote GA, Cotton PB, et al. Evaluation of pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review. Clin Gastroenterol Hepatol. 2015;13(7):1231–9.
Heinzow HS, Lenz P, Lenze F, Domagk D, Domschke W, Meister T. Feasibility of snare papillectomy in ampulla of Vater tumors: meta-analysis and study results from a tertiary referral center. Hepatogastroenterology. 2012;59(114):332–5.
De Palma GD. Endoscopic papillectomy: indications, techniques, and results. World J Gastroenterol. 2014;20(6):1537–43.
Charton JP, Deinert K, Schumacher B, Neuhaus H. Endoscopic resection for neoplastic diseases of the papilla of Vater. J Hepatobiliary Pancreat Surg. 2004;11(4):245–51.
Vogt M, Jakobs R, Benz C, Arnold JC, Adamek HE, Riemann JF. Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up. Dig Liver Dis. 2000;32(4):339–45.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Video Legend
Endoscopic ampullectomy (MOV 130,921 kb).
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Feurer, M.E., Hilgenfeldt, E.G., Draganov, P.V. (2016). Endoscopic Ampullectomy: Who, When, and How. In: Adler, D. (eds) Advanced Pancreaticobiliary Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-26854-5_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-26854-5_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-26852-1
Online ISBN: 978-3-319-26854-5
eBook Packages: MedicineMedicine (R0)