Nationwide Survey on Endoscopic Papillectomy for Ampullary Adenoma: Current Practices and Variability

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Ampullary adenomas are precancerous lesions requiring precise management to prevent malignancy.
• Endoscopic papillectomy (EP) offers a less invasive alternative to surgery, but practice variations exist.
• Understanding current real-world approaches is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate contemporary diagnostic, therapeutic, and surveillance strategies for ampullary adenomas among pancreatobiliary endoscopists.
• To identify variations in practice based on endoscopist experience.

Main Methods:

• A nationwide cross-sectional survey was conducted among Korean pancreatobiliary endoscopists.
• A 29-item questionnaire assessed diagnostic methods, procedural techniques, and follow-up strategies.
• Responses were analyzed and stratified by endoscopic papillectomy (EP) experience (≤10 years vs. >10 years).

Main Results:

• Diagnostic and procedural strategies were largely similar between experience groups.
• Single pigtail plastic stents were preferred for prophylactic pancreatic stenting, especially by less experienced endoscopists (92.5% vs 66.7%, p=0.008).
• Fully covered self-expandable metal stents were more frequently used for post-procedural bleeding by less experienced endoscopists (47.5% vs 11.1%, p=0.001).
• Significant heterogeneity was observed in surveillance intervals, follow-up modalities, and stent removal timing.

Conclusions:

• While general clinical practices for ampullary adenoma management show standardization, specific procedural and post-procedural approaches exhibit considerable variability.
• These findings underscore the necessity for developing refined guidelines to promote a more consistent and comprehensive approach to endoscopic papillectomy (EP).