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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 26, 2015; 5(3): 127-135
Published online Sep 26, 2015. doi: 10.5662/wjm.v5.i3.127
Endoscopic management of adenomatous ampullary lesions
Jesús Espinel, Eugenia Pinedo, Vanesa Ojeda, Maria Guerra del Rio
Jesús Espinel, Department of Digestive Diseases, Hospital Universitario de León, 24071 León, Spain
Eugenia Pinedo, Department of Radiodiagnosis, Hospital Universitario de León, 24071 León, Spain
Vanesa Ojeda, Department of Digestive Diseases, Hospital Universitario Dr. Negrín, 35012 Las Palmas de Gran Canaria, Spain
Maria Guerra del Rio, Consultant Gastroenterologist, Burton Hospitals NHS foundation trust, DE13 ORB Burton on Trent, United Kingdom
Author contributions: Espinel J wrote the paper; Pinedo E, Ojeda V and Guerra del Rio M perfomed the collected the data.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jesús Espinel, MD, Department of Digestive Diseases, Hospital Universitario de León, Altos de Nava S/N, 24071 León, Spain. espinel.jesus@gmail.com
Telephone: +34-987-237400 Fax: +34-987-209644
Received: March 2, 2015
Peer-review started: March 2, 2015
First decision: March 20, 2015
Revised: May 18, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: September 26, 2015
Abstract

Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented.

Keywords: Papillary tumors, Endoscopic ampullectomy, Endoscopic ultrasound, Ampullary adenoma, Pancreatitis

Core tip: Adenomatous ampullary lesions are rare. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS) have changed the management of patients with these lesions. Endoscopic ampullectomy is a technique that has revolutionized the treatment of these lesions avoiding potential complications of surgery. We herein discuss the epidemiology, the role of EUS in the local staging and the role of endoscopy in the treatment of the adenomatous ampullary neoplasms.