Endoscopic Management of Ampullary Neoplasms
Summary
Ampullary neoplasms, arising at the ampulla of Vater, encompass a spectrum from benign adenomas to early invasive carcinomas. Endoscopic management has evolved into a minimally invasive alternative to surgery for carefully selected lesions. Initial evaluation employs side-viewing duodenoscopy augmented by endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS) and magnetic resonance cholangiopancreatography (MRCP) to stage tumour depth, ductal involvement and regional lymph nodes. Tissue diagnosis is achieved through targeted forceps biopsy under direct vision. Endoscopic papillectomy now extends beyond small benign adenomas to include early ampullary carcinoma, giant laterally spreading lesions and intraductal extensions. Key technical refinements—such as submucosal lifting, en bloc snare resection, prophylactic pancreatic stenting and rectal nonsteroidal anti-inflammatory drugs—have reduced procedure-related pancreatitis and stenosis. Although bleeding, perforation and pancreatitis remain concerns, most adverse events can be managed endoscopically. Recurrence rates vary according to lesion size, periampullary extension and familial syndromes; rigorous surveillance with repeat endoscopy and adjunctive ablative therapies can achieve long-term control. Global adoption reflects a shift towards organ-preserving care, with demonstrated reductions in morbidity, healthcare costs and impact on patient quality of life.
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Endoscopic Management of Ampullary Neoplasms publication trend
The graph below shows the total number of articles in endoscopic management of ampullary neoplasms across all publications each year (not limited to Nature Index journals).
Technical terms
Ampulla of Vater: Convergence point of the bile and pancreatic ducts into the duodenum.
Endoscopic papillectomy: Snare-based resection of ampullary lesions via side-viewing duodenoscope.
Endoscopic ultrasonography (EUS): Ultrasound imaging probe integrated into the endoscope for local staging.
Intraductal ultrasonography (IDUS): High-frequency ultrasound probe advanced into the bile or pancreatic duct for detailed wall assessment.
En bloc resection: Removal of the entire lesion in a single specimen to minimise residual disease and recurrence.
References
- Diagnostic accuracy of cross-sectional and endoscopic imaging in ampullary tumours: systematic review. British Journal of Surgery (2024).
- Incidence and risk factors for recurrence of ampullary adenomas after endoscopic papillectomy: Comparative analysis of familial adenomatous polyposis and sporadic ampullary adenomas in an international multicenter cohort. Digestive Endoscopy (2024).
- Updates on the Management of Ampullary Neoplastic Lesions. Diagnostics (2023).
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