Treatment of Ampullary Adenoma Without Intraductal Extension

This protocol addresses patients with ampullary adenoma in whom endoscopic and imaging assessment has confirmed the absence of intraductal extension — a key determinant that guides the choice of intervention.

Where intraductal extension has been excluded, endoscopic papillectomy is the recommended primary approach. ESGE guidelines support this strategy based on established outcomes in technical success, clinical success, morbidity, and recurrence rates.

In the setting of residual or recurrent adenoma following initial endoscopic treatment, complementary endoscopic techniques — including ablative modalities — may be considered. The full protocol specifies the selection criteria, procedural sequence, and management algorithm.