title: Endoscopic diagnosis and treatment of ampullary neoplasm (with video).
abstract: OBJECTIVE
  For ampullary cancer, pancreaticoduodenectomy is considered to be the standard treatment. Endoscopic papillectomy (EP) has been utilized in cases of ampullary adenoma since the early 1980s. We aimed to provide a review concerning EP.
  
  
  METHODS
  We conducted a review of studies regarding EP for ampullary neoplasms.
  
  
  RESULTS
  Since neither lymphatic permeation, vascular invasion, nor lymph node metastasis is observed in patients with ampullary cancer limited to the mucosa, EP of such tumors without ductal infiltration into the pancreatic/bile duct can be justified as radical treatment. For its application in patients with ampullary neoplasms, accurate pretreatment staging is indispensable. EUS, which can be carried out on an outpatient basis with a low risk of complications, is useful for differential diagnosis as well as detection of periampullary tumors. Although intraductal US of the bile duct tends to result in overestimation of tumor staging in cases of ampullary neoplasm, it can provide useful information for making therapeutic decisions, especially in cases appropriate for EP. While the technical success rate of EP is high, the complication rate and recurrence rate are not as low as a satisfactory level. Pancreatic duct stenting after EP is expected to contribute to prevention of post-EP pancreatitis. There is no consensus regarding the mode of resection current nor the need for addition of biliary/pancreatic sphincterotomy and biliary stenting.
  
  
  CONCLUSIONS
  EP has been reported to be useful in selected patients with ampullary neoplasms. Data on further long-term follow up after EP are awaited.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan. keiito@openhp.or.jp
authors.forename: Kei
authors.initials: K
authors.lastname: Ito
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Noda
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D019160:Endosonography; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009367:Neoplasm Staging; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D012680:Sensitivity and Specificity; D016717:Sphincterotomy, Endoscopic; D015607:Stents