title: Endoscopic ampullectomy: a technical review.
abstract: OBJECTIVE
  This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.
  
  
  METHODS
  We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.
  
  
  RESULTS
  Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.
  
  
  CONCLUSIONS
  Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.
authors.affiliation: Digestivo, Hospital de León, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Espinel
authors.affiliation: Radiodiagnostico, Hospital de León, España.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Pinedo
authors.affiliation: Digestivo, Hospital Universitario Dr. Negrín. Las Palmas de Gran Canaria, España.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Ojeda
authors.affiliation: Department of Digestive Diseases, Burton Hospitals NHS. United Kingdom , UK.
authors.forename: María
authors.initials: M
authors.lastname: Guerra Del Río
mesh_terms: D000236:Adenoma / Q000601:surgery*; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D006801:Humans