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Related Concept Videos

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Related Experiment Video

Updated: May 2, 2026

Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
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Endoscopic papillectomy: indications, techniques, and results.

Giovanni D De Palma1

  • 1Giovanni D De Palma, Center of Excellence for Technical Innovation in Surgery, Department of Clinical Medicine and Surgery, University of Naples Federico II School of Medicine, 80131 Naples, Italy.

World Journal of Gastroenterology
|March 4, 2014
PubMed
Summary

Endoscopic papillectomy (EP) offers a safe alternative to surgery for ampullary adenomas, with high success rates. Careful patient selection and technique are crucial to minimize risks and recurrence, though most recurrences are manageable.

Keywords:
Endoscopic papillectomyEndoscopic retrograde cholangiopancreatographyEndoscopic sphincterotomyMajor duodenal papillaPapillary neoplasms

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery

Background:

  • Endoscopic papillectomy (EP) is a recognized treatment for sporadic ampullary adenomas.
  • Established indications for EP include adenoma size up to 5 cm, absence of intraductal growth, and no endoscopic signs of malignancy.
  • Endoscopic ultrasound (EUS) is preferred for staging ampullary neoplasms, outperforming CT in assessing tumor size, nodal metastases, and vascular invasion.

Purpose of the Study:

  • To review the current status of endoscopic papillectomy for ampullary adenomas.
  • To discuss indications, techniques, and potential complications of EP.
  • To highlight the role of EUS in preoperative assessment.

Main Methods:

  • Review of existing literature on endoscopic papillectomy.
  • Discussion of accepted criteria for EP and the role of endoscopic ultrasound (EUS).
  • Analysis of complications and recurrence rates associated with EP.

Main Results:

  • EP has high success and low recurrence rates for sporadic ampullary adenomas.
  • EUS is superior to CT for preoperative staging of ampullary neoplasms.
  • Complications include early (pancreatitis, bleeding, perforation, cholangitis) and late (papillary stenosis) events.
  • Recurrence rates for benign lesions are up to 20%, influenced by tumor factors and endoscopist expertise.

Conclusions:

  • Endoscopic papillectomy is a viable alternative to surgery for selected ampullary adenomas.
  • Careful patient selection based on size, intraductal spread, and malignancy signs is essential.
  • Post-procedure stenting can mitigate risks like pancreatitis and stenosis.
  • Recurrent lesions are often benign and amenable to repeat endoscopic treatment.