Treatment of Ampullary Adenoma Presenting as a Laterally Spreading Tumor Involving the Papilla (LST-p)

This protocol addresses the management of ampullary adenoma in the specific setting of a laterally spreading tumor that extends significantly beyond the papilla — a presentation that influences the choice of intervention.

Clinical Scenario

Laterally spreading tumor involving the papilla (LST-p) — a laterally spreading ampullary tumor with a ≥ 10-mm extension beyond the ampullary mound, or with an extrapapillary component involving the duodenal wall that exceeds the size of the papillary adenoma itself.

Treatment Approach

In this setting, a surgical approach is the preferred strategy. The full protocol specifies the recommended procedure, the circumstances under which it is indicated over alternative endoscopic options, and the relevant clinical criteria that guide the decision.

Complete indication criteria, procedural guidance, and management algorithm available in the full protocol →

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1055/a-1397-3198

A laterally spreading tumor involving the papilla Vateri (LST-p) is defined as a laterally spreading ampullary tumor with a ≥ 10-mm extension beyond the ampullary mound or with an extrapapillary component, involving the duodenal wall, that is greater than the size of the papillary adenoma.

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.

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