Treatment of Ampullary Adenoma with Intraductal Involvement Greater Than 20 mm or When Endoscopic Resection Is Not Technically Feasible

Ampullary adenomas usually undergo endoscopic papillectomy, but certain anatomical or tumour features place a patient outside the scope of endoscopic management. In these situations, a distinct treatment pathway is recommended.

Clinical scenario

This protocol applies to ampullary adenoma with intraductal involvement greater than 20 mm, or where endoscopic resection is not feasible for technical reasons — such as the presence of a periampullary diverticulum or a tumour size greater than 4 cm. These features are recognised thresholds at which endoscopic papillectomy is not considered an adequate or safe option.

Treatment approach

When these criteria are met, a surgical approach is the recommended course of management. The full structured regimen — including the specific surgical procedure, technical considerations, and post-procedural guidance — is available in the complete protocol. Full protocol required for the complete regimen →

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References

ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm).

However, surgical transduodenal ampullectomy is still an acceptable option for ampullary adenoma, being preferred to endoscopic papillectomy in the following settings: intraductal involvement; impossibility of performing endoscopic papillectomy for technical reasons (e. g. diverticulum, size > 4 cm); incomplete resection after endoscopic papillectomy with positive margins; and local recurrence not treatable by endoscopy.

DOI: 10.1055/a-1397-3198

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