Management of periampullary adenoma

The periampullary region is the most common site of adenomatous change in the small bowel, particularly in patients with familial adenomatous polyposis (FAP) syndromes. These lesions have been shown to progress to malignancy in a manor analogous to colonic polyps. Following colectomy, the periampullary region is the commonest site of gastrointestinal malignancy in FAP patients. The periampullary region is within easy reach of forward- and side-viewing endoscopes and therefore endoscopic surveillance in FAP patients is both easy and prudent. Furthermore, there is accumulating evidence that endoscopic resection and/or ablation are the treatment of choice for periampullary adenomas. However, the optimal timing of surveillance and best methods of ablation remain to be determined. This paper reviews the literature on the endoscopic management of periampullary adenoma as well as outlining our current approach to this challenging problem.