ASGE Annual Postgraduate Course at DDW: UPPER GI Only (On-Demand) | May 2019-Endoscopic Therapy for Ampullary and Duodenal Adenomas: Off with their heads!

Endoscopic Therapy for Ampullary and Duodenal Adenomas: Off with their heads!

Video Transcription

Video Summary

Ampullary and duodenal adenomas are rare and often present as incidental findings. Symptoms usually indicate advanced disease. Surgical removal poses challenges due to the narrow lumen, location, vascular supply, and surrounding structures. Differential diagnosis includes brunner gland hyperplasia, hematomas, neuroendocrine tumors, and serrated adenomas. Sporadic non-ampullary duodenal adenomas can be treated with endoscopic resection using specialized equipment and techniques. The size of the adenoma determines the success rates and risk of recurrence and bleeding. After resection, patients are placed on clear liquids and proton pump inhibitors for four weeks. Follow-up is recommended at 6 to 12 months. Ampullary tumors make up 5% of gastrointestinal neoplasms and can be managed with tissue sampling, endoscopic ultrasound, and endoscopic papillectomy. Histopathology confirmation is important. Prophylactic pancreatic duct stenting and endomethicin administration are recommended. Interprocedural bleeding can be treated with diluted epinephrine and clips, and additional techniques may be used for incomplete resection or recurrence. Successful outcomes are achievable, although complications like pancreatitis are possible. Endoscopic therapy offers a safe and effective alternative to surgical resection for most cases.

Keywords

ampullary adenomas

duodenal adenomas

endoscopic resection

follow-up recommendations

endoscopic therapy