Insights and updates on endoscopic papillectomy

Expert Rev Gastroenterol Hepatol. 2020 Jun;14(6):435-444. doi: 10.1080/17474124.2020.1766965. Epub 2020 May 22.


Introduction: Endoscopic papillectomy (EP) has been established as a useful endoscopic therapy by the efforts of many pancreatobiliary endoscopists and is presently accepted as a reliable alternative therapy to surgery in patients with ampullary adenoma. Moreover, there have been numerous advancements in EP techniques in recent years. Various approaches and attempts toward expanding the indications of endoscopic resection have been reported. Furthermore, the management and prevention of adverse events (AEs) and endoscopic treatment for remnant or recurrent lesions have also been reported. In the present review, we focus on recent advancements in the EP technique, as well as speculate on the future issues of EP.

Area covered: This review of EP encompasses the indications, preoperative assessments, endoscopic techniques, outcomes, and AEs of EP, post-EP surveillance techniques, and treatments for remnant or recurrence lesions.

Expert opinion: The ultimate goal of EP is the complete resection of ampullary tumors, regardless of whether they are adenomatous or carcinomatous lesions, without causing any AEs. Therefore, the most important issue is preoperative evaluation, that is, the accurate diagnosis of lesions contraindicated for EP. In addition, further research on the prevention of AEs is also necessary towards establishing EP as a safe endoscopic procedure.

Keywords: Ampullary adenomas; ampullary carcinoma; endoscopic ablative therapy; endoscopic papillectomy; endoscopic ultrasonography; familial adenomatous polyposis; intraductal radiofrequency ablation; intraductal ultrasonography; post-EP pancreatitis; prophylactic pancreatic stent.

Publication types

  • Review

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / surgery*
  • Ampulla of Vater / surgery*
  • Common Bile Duct Neoplasms / diagnosis
  • Common Bile Duct Neoplasms / surgery*
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / methods
  • Digestive System Surgical Procedures / trends
  • Duodenoscopy
  • Forecasting
  • Humans
  • Perioperative Care
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / surgery*
  • Sphincterotomy, Endoscopic* / adverse effects
  • Sphincterotomy, Endoscopic* / methods
  • Sphincterotomy, Endoscopic* / trends