Treatment of Ampullary Adenoma with Intraductal Extension of 20 mm or Less
Ampullary adenomas that involve the bile duct or pancreatic duct up to 20 mm present a specific endoscopic management scenario. When intraductal extension falls within this range, a defined procedural approach is recommended.
Clinical scenario: Ampullary adenoma with intraductal extension of 20 mm or less — a setting where endoscopic resection is the primary modality, with selective use of complementary intraductal techniques in expert centers where anatomical involvement warrants them.
Approach
Management is built around endoscopic papillectomy, with pre-procedural preparation, specific resection technique, and — in expert centers where intraductal extension is present — complementary ablative and stenting measures; the complete sequence and prophylactic protocol are detailed in the full regimen.
References
DOI: 10.1055/a-1397-3198
- ESGE suggests the use, in expert centers, of complementary techniques (thermal ablation by cystotome, or radiofrequency ablation [RFA]) with temporary biliary stenting, for ampullary adenoma with ≤ 20-mm intraductal extension.
- ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.
- ESGE suggests routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic papillectomy in all patients without contraindication to administration of nonsteroidal anti-inflammatory drugs.
- ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.
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