Endoscopic Papillectomy: Introduction and How to Treat

Ampullary tumor is a comparatively rare tumor derived from the duodenal papilla. It is thought to be associated with the progression of adenoma to carcinoma and is recognized as a premalignant lesion. Recently, endoscopic papillectomy, snaring resection of the ampulla, has been accepted as a less invasive alternative to surgical treatment for cases of ampullary adenoma or adenocarcinoma in adenoma in patients for whom curative resection was possible. The rates of curative resection were reported to be 52–92%, with 0–33% of recurrence rates. However the indications, preprocedural diagnosis, and technique of endoscopic papillectomy are still not standardized. Experts agree that endoscopic ultrasonography is useful, for the diagnosis on the presence of invasion to the muscularis propria, intraductal extension of the lesion, and metastasis to regional lymph nodes. Pancreatitis and bleeding are the most common complications. Pancreatitis is considered to occur due to obstruction of pancreatic duct orifice and thermal damage to the pancreatic parenchyma. Pancreatic stent placement is recommended to avoid obstruction of pancreatic duct orifice. The endoscopic surveillance after endoscopic papillectomy is essential for detecting recurrence of ampullary adenoma.