Treatment of Ampullary Adenoma Without Intraductal Extension
This protocol addresses ampullary adenoma in patients where intraductal extension is absent — a key anatomical distinction that shapes the selection of the appropriate intervention.
In ampullary adenoma without intraductal extension, the absence of ductal involvement is central to the therapeutic decision. Guidelines from ESGE recommend endoscopic papillectomy in this setting based on its outcomes across technical success, clinical success, morbidity, and recurrence. However, alternative interventions exist and remain relevant when endoscopic management is not feasible or has been insufficient.
When a surgical route is indicated, the protocol specifies a defined operative technique targeting the ampullary region. The full decision criteria — including when surgery is preferred, and the complete procedural pathway — are available in the structured protocol.
References
- ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcomes (technical and clinical success, morbidity, and recurrence).
- 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.