CLINICAL REVIEWSEndoscopic Ampullectomy Techniques and OutcomesPatel, Roshan BS; Varadarajulu, Shyam MD; Wilcox, C. Mel MD, MSPH Author Information Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL The authors declare that they have nothing to disclose. Reprints: C. Mel Wilcox, MD, MSPH, Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, 1808 7th Avenue, So. BDB 380, Birmingham, AL 35294-0001 (e-mail: [email protected]). Journal of Clinical Gastroenterology: January 2012 - Volume 46 - Issue 1 - p 8-15 doi: 10.1097/MCG.0b013e318233a844 Buy Metrics Abstract Advances in endoscopic ampullectomy continue to mitigate concerns regarding incomplete removal of ampullary neoplasias, postprocedure complications, and insufficient treatment of tumors with undetected malignant foci or intraductal invasion. Advanced T staging of these lesions with endoscopic ultrasound and intraductal ultrasound, while useful tools for selection of candidates for snare polypectomy, should be limited to lesions either greater than 3 cm, bearing the macroscopic appearance of malignancy or unamenable to endoscopic therapy. Intraductal ultrasound has demonstrated T-staging accuracy superior to endoscopic ultrasound. One prospective study of prophylactic pancreatic stent placement and a number of retrospective studies have reported reduced complication rates. Recent studies continue to propose follow-up endoscopic retrograde cholangiopancreatography at 3-month intervals after ampullectomy to evaluate for recurrence and ablate residual tissue, with the interval increased to 6 to 12 months for 5 years on obtaining negative biopsies for adenomatous tissue. The development of thermal ablation, notably argon plasma coagulation, for fulguration of residual unresectable tumor, biductal sphincterotomy and prophylactic pancreatic pancreatic stent placement, and advanced diagnostic imaging mitigate the concerns leveled against endoscopic ampullectomy. In experienced hands, endoscopic papillectomy of noninvasive, benign ampullary lesions is a safe, technically feasible, and effective alternative to surgical resection. This study will focus on diagnosis and staging of ampullary adenomas and reviews indications for, and outcomes and complications of, endoscopic papillectomy. © 2012 Lippincott Williams & Wilkins, Inc.