يتناول هذا البروتوكول إدارة الورم الغدي الحليمي في السياق المحدد لورم منتشر جانبياً يمتد بشكل كبير خارج الحليمة — وهو مظهر يؤثر على اختيار التدخل.
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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