ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy

Bilal_CaseSession1

Pdf Summary

This document discusses the evaluation and resection of ampullary lesions. Ampullary adenomas are rare, with a prevalence of 0.04% to 0.12% based on autopsy studies. There is a 300-fold increase in polyposis syndrome (FAP) in patients with ampullary adenomas. Examining the ampulla requires a side viewing scope, which may have limitations due to lack of comfort or training. Often, advanced endoscopists are referred for the examination, which can lead to additional costs and repeat endoscopy. <br /><br />A study comparing standard EGD and cap-assisted EGD found that cap-assisted EGD had a 97% success rate in evaluating the major papilla, while the standard EGD group had a success rate of 24%. <br /><br />The document also presents a case example of a 77-year-old male who was incidentally found to have a duodenal mass. After further evaluation, a neuroendocrine differentiated neoplasm originating from the deep mucosal layer was discovered. The patient underwent endoscopic papillectomy, which resulted in a successful resection of the lesion. <br /><br />The document provides several take-home points related to the resection of ampullary lesions, including the importance of resecting only biopsy-proven lesions and the potential need for pre-resection MRCP/EUS. It is recommended to perform resection for lesions larger than 2 cm in size, those causing cholestasis or jaundice, and to cannulate the pancreatic duct prior to resection. Thin wire snares and the EndoCut Q technique are preferred for resection. Surgical evaluation is recommended for ingrowth into the pancreatic duct or common bile duct larger than 1 cm. The use of biliary sphincterotomy and clipping the distal margin after stent placement are also discussed. <br /><br />Overall, this document provides an overview of the evaluation and resection of ampullary lesions and offers important considerations for clinical practice.

Keywords

ampullary lesions

evaluation

resection

ampullary adenomas

polyposis syndrome

cap-assisted EGD

neuroendocrine differentiated neoplasm

endoscopic papillectomy

MRCP/EUS

cholestasis