Endoscopic Management of Ampullary Adenomas: A Comprehensive Review

Abstract

Ampullary adenomas are rare outgrowths at the ampulla of Vater that may progress into cancer via the adenoma-to-carcinoma sequence, particularly in individuals with hereditary polyposis syndrome. Many are diagnosed incidentally or once the lesion becomes large enough to cause obstruction. Traditionally managed surgically with high morbidity and mortality, advances in imaging and therapy have made endoscopic ampullectomy the first-line treatment for noninvasive lesions. Despite its high success rate and favorable safety profile, complications such as pancreatitis, ductal stenosis, bleeding, recurrence, and perforation can occur. Recommendations for optimal endoscopic techniques and surveillance intervals are largely based on expert opinion in interventional endoscopy and findings from small-scale studies. This review provides an updated framework for the diagnosis and management of ampullary adenomas.

Keywords: ampullary adenocarcinoma; ampullary adenoma; endoscopic ampullectomy; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound.

Figure 1

Example of an ampullary lesion.

Figure 2

Example of an ampullary adenoma (yellow box) in a patient with familial adenomatous polyposis (FAP), accompanied by multiple other duodenal adenomas (yellow arrows).

Figure 3

Example of a large ampullary adenoma with predominant intraductal extension.

Figure 4

An ampullary adenoma with intraductal extension was identified. Following surgical intervention, the final pathology revealed an ampullary adenocarcinoma staged as pT2 N0 (Stage 1B).

Figure 5

Example of an ampullary adenocarcinoma presenting as a large, irregular, friable mass prone to bleeding.