The Role of Endoscopic Ultrasonography (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Evaluation and Management of Ampullary Adenomas

The endoscopic evaluation and management of ampullary adenomas is an excellent example of the complimentary use of endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in interventional endoscopy. EUS has an important role in the staging of ampullary masses and in the evaluation of underlying malignancy. Various technical approaches to EUS imaging of the ampulla have been described and each offers specific information regarding the resectability of these lesions. Short of surgical resection, EUS appears to offer the most detailed information regarding the T stage of ampullary lesions. This important information can be used to determine the likelihood of successful endoscopic therapy. Endoscopic papillectomy techniques have evolved over the past two decades. The technical issues regarding endoscopic papillectomy are driven more by anecdotes than evidence. The technique of endoscopic papillectomy is described in detail with a review of current practice variations and supportive literature. The incidence of complications reported in the recent literature and the need for surveillance after successful resection of ampullary adenomas are discussed.