Endoscopy 2021; 53(04): 429-448
DOI: 10.1055/a-1397-3198
Guideline

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Geoffroy Vanbiervliet
 1  Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
,
Marin Strijker
 2  Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Marianna Arvanitakis
 3  Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Arthur Aelvoet
 2  Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Urban Arnelo
 4  Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
,
 5  Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
,
Olivier Busch
 2  Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
 6  Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Lumir Kunovsky
 7  Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
 8  Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
,
Alberto Larghi
 9  Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
,
10  Aziende Socio Sanitaria Territoriale Rhodense, Gastroenterology, Garbagnate Milanese, Italy
,
Alan Moss
11  Department of Endoscopic Services, Western Health, Melbourne, Australia
12  Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
,
Bertrand Napoleon
13  Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
,
Manu Nayar
14  Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
,
15  Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre - Université de Paris, Paris, France
,
Stefan Seewald
16  Gastroenterology Center, Klinik Hirslanden, Zurich, Switzerland
,
17  Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
,
Jeanin E. van Hooft
18  Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
› Author Affiliations

Main Recommendations

1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.

Strong recommendation, low quality evidence.

2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.

Strong recommendation, low quality evidence.

3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).
Strong recommendation, moderate quality evidence.

4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.

Strong recommendation, low quality evidence.

5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.

Weak recommendation, low quality evidence.

6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.
Strong recommendation, moderate quality evidence.

7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.

Strong recommendation, moderate quality evidence.

8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.

Strong recommendation, low quality evidence.



Publication History

Publication Date:
16 March 2021 (online)

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