Elsevier

Gastrointestinal Endoscopy

Volume 82, Issue 5, November 2015, Pages 773-781
Gastrointestinal Endoscopy

Guideline
The role of endoscopy in ampullary and duodenal adenomas

https://doi.org/10.1016/j.gie.2015.06.027Get rights and content

Section snippets

Ampullary adenomas

Adenomas of the major duodenal papilla, also known as ampullary adenomas, can occur sporadically or in the context of genetic syndromes such as familial adenomatous polyposis (FAP). These lesions have the potential to undergo malignant transformation to ampullary cancer, and their clinical significance extends beyond the need to treat any associated symptoms. Endoscopic screening and surveillance of high-risk patients, such as those with FAP, also has led to increasing recognition of ampullary

Nonampullary duodenal polyps

Polyps of the duodenum that do not involve the major duodenal papilla can occur sporadically or in the context of genetic syndromes such as FAP or Peutz-Jeghers syndrome. Adenomas in these patients also have the potential to undergo malignant transformation into duodenal cancer.

Recommendations

  • 1.

    We recommend that biopsy specimens be obtained and evaluated from ampullary lesions suspicious for neoplasia before attempted endoscopic resection. ⊕⊕⊕○

  • 2.

    We recommend EUS for large ampullary lesions or duodenal polyps with features concerning for malignancy before endoscopic or surgical resection. ⊕⊕⊕○

  • 3.

    We suggest ERCP with both biliary and pancreatic duct evaluation at the time of endoscopic papillectomy to assess for evidence of extension into either ductal system. ⊕⊕○○

  • 4.

    We recommend prophylactic

Disclosure

M. Khashab is a consultant to and member of the Medical Advisory Board for Boston Scientific and a consultant to Olympus and receives research support from Cook Medical. K. Chathadi is a consultant to Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.

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