Endoscopic Ampullectomy: Management of Periampullary/Duodenal Adenomas in Familial Adenomatous Polyposis

The majority of persons with familial adenomatous polyposis (FAP) develop duodenal adenomas by the seventh decade of life. Ampullary and peri-ampullary adenomas pose a significant clinical dilemma because of malignant potential and limited treatment options. Recently, clinical evidence suggests that endoscopic ampullectomy is an effective strategy for management of ampullary neoplasms. Various methods are used to perform endoscopic ampullectomy, but generally a polypectomy snare is utilized for polyp resection with or without the addition of thermal ablation to remove residual tissue. Placement of a pancreatic duct stent is recommended to decrease the risk of acute pancreatitis and is supported by recent evidence. Several clinical trials have evaluated endoscopic ampullectomy with a high efficacy rate and an acceptable complication rate that includes acute pancreatitis, bleeding, perforation, orifice stenosis, and, rarely, death. In the FAP population, routine endoscopic follow-up with repeat treatment is necessary because there is a risk of recurrence.