TY - JOUR
T1 - Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
AU - Vanbiervliet, Geoffroy
AU - Strijker, Marin
AU - Arvanitakis, Marianna
AU - Aelvoet, Arthur
AU - Arnelo, Urban
AU - Beyna, Torsten
AU - Busch, Olivier
AU - Deprez, Pierre H.
AU - Kunovsky, Lumir
AU - Larghi, Alberto
AU - Manes, Gianpiero
AU - Moss, Alan
AU - Napoleon, Bertrand
AU - Nayar, Manu
AU - Pérez-Cuadrado-Robles, Enrique
AU - Seewald, Stefan
AU - Barthet, Marc
AU - van Hooft, Jeanin E.
N1 - Funding Information: M. Arvanitakis has received lecture fees from Olympus. T. Beyna provides consultancy to and gives lectures for Boston Scientific and Cook Medical (ongoing). J.E. van Hooft’s department has received research grants from Cook Medical (from 2014 to 2019) and Abbott (from 2014 to 2017); she has received lecture fees from Medtronics (from 2014 to 2015, 2019) and Cook Medical (from 2019); she has received consultancy fees from Boston Scientific (from 2014 to 2017). G. Van-biervliet has provided consultancy to Boston Scientific and Cook Medical (both from 2019 to present). A. Aelvoet, U. Arnelo, M. Barthet, O. Busch, P. Deprez, A. Larghi, G. Manes, A. Moss, B. Napoleon, M. Nayar,E. Pérez-Cuadrado-Robles, L. Kunovsky, S. Seewald, and M. Strijker, declare that they have no conflicts of interest. Publisher Copyright: © 2021. European Society of Gastrointestinal Endoscopy. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven. Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors. Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence). Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy. Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory. Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy. Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy. Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years. Strong recommendation, low quality evidence.
AB - Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven. Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors. Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence). Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy. Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory. Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy. Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy. Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years. Strong recommendation, low quality evidence.
UR - http://www.scopus.com/inward/record.url?scp=85102904039&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1397-3198
DO - https://doi.org/10.1055/a-1397-3198
M3 - Review article
C2 - 33728632
SN - 0013-726X
VL - 53
SP - 429
EP - 448
JO - Endoscopy
JF - Endoscopy
IS - 4
ER -