Papillectomy: Clinical Results

Endoscopic papillectomy (EP) is a safe and effective first-line treatment for small tumors of the ampulla of Vater. EP may be considered as a curative treatment in case of ampullary adenoma with high-grade intraepithelial dysplasia or well-differentiated in situ tumor with negative resection margins. Predictors of long-term success (>85% of cases) include patient age >48 years, lesion size ≤24 mm, male sex, absence of polyposis syndrome, and intestinal histological subtype. Adverse events range from 10 to 35% and are successfully managed in most of the cases, sometimes after multidisciplinary evaluation. The incidence of residual/recurrent adenoma is high (about 40%), but it is balanced by the successful endoscopic re-treatment. Endoscopic surveillance is mandatory for identifying and managing residual/recurrent adenomatous tissue particularly if the surveillance intervals are not standardized.