Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Main Recommendations

1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.

Strong recommendation, low quality evidence.

2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.

Strong recommendation, low quality evidence.

3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).
Strong recommendation, moderate quality evidence.

4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.

Strong recommendation, low quality evidence.

5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.

Weak recommendation, low quality evidence.

6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.
Strong recommendation, moderate quality evidence.

7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.

Strong recommendation, moderate quality evidence.

8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.

Strong recommendation, low quality evidence.

Publication History

Article published online:
16 March 2021

• References

• 1 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895
• 2 Ramai D, Ofosu A, Singh J. et al. Demographics, tumor characteristics, treatment, and clinical outcomes of patients with ampullary cancer: a Surveillance, Epidemiology, and End Results (SEER) cohort study. Minerva Gastroenterol Dietol 2019; 65: 85-90
• 3 Rostain F, Hamza S, Drouillard A. et al. Trends in incidence and management of cancer of the ampulla of Vater. World J Gastroenterol 2014; 20: 10144-10150
• 4 Van Dyke AL, Shiels MS, Jones GS. et al. Biliary tract cancer incidence and trends in the United States by demographic group, 1999–2013. Cancer 2019; 125: 1489-1498
• 5 Offerhaus GJ, Giardiello FM, Krush AJ. et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology 1992; 102: 1980-1982
• 6 Fischer H-P, Zhou H. Pathogenesis of carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004; 11: 301-309
• 7 Amin MB, Greene FL, Edge SB. et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017; 67: 93-99
• 8 Imamura T, Yamamoto Y, Sugiura T. et al. The prognostic relevance of the new 8th edition of the Union For International Cancer Control classification of TNM staging for ampulla of vater carcinoma. Ann Surg Oncol 2019; 26: 1639-1648
• 9 Kim SJ, An S, Kang HJ. et al. Validation of the eighth edition of the American Joint Committee on Cancer staging system for ampulla of Vater cancer. Surgery 2018; 163: 1071-1079
• 10 Hester CA, Dogeas E, Augustine MM. et al. Incidence and comparative outcomes of periampullary cancer: A population-based analysis demonstrating improved outcomes and increased use of adjuvant therapy from 2004 to 2012. J Surg Oncol 2019; 119: 303-317
• 11 Nassour I, Mokdad AA, Minter RM. et al. Racial and ethnic disparities in a national cohort of ampullary cancer patients. J Surg Oncol 2018; 117: 220-227
• 12 Kimchi NA, Mindrul V, Broide E. et al. The contribution of endoscopy and biopsy to the diagnosis of periampullary tumors. Endoscopy 1998; 30: 538-543
• 13 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
• 14 Venu RP, Geenen JE. Diagnosis and treatment of diseases of the papilla. Clin Gastroenterol 1986; 15: 439-456
• 15 Lee HS, Jang JS, Lee S. et al. Diagnostic accuracy of the initial endoscopy for ampullary tumors. Clin Endosc 2015; 48: 239-246
• 16 Abdelhafez M, Phillip V, Hapfelmeier A. et al. Cap assisted upper endoscopy for examination of the major duodenal papilla: a randomized, blinded, controlled crossover study (CAPPA Study). Am J Gastroenterol 2017; 112: 725-733
• 17 Abdelhafez M, Phillip V, Hapfelmeier A. et al. Comparison of cap-assisted endoscopy vs. side-viewing endoscopy for examination of the major duodenal papilla: a randomized, controlled, non-inferiority crossover study. Endoscopy 2019; 51: 419-426
• 18 Shi X, Luo H, Ning B. et al. Effect of cap-assisted esophagogastroduodenoscopy on examination of the major duodenal papilla: a non-inferior, randomized controlled trial. Endoscopy 2019; 51: 427-435
• 19 Napoleon B, Gincul R, Ponchon T. et al. Endoscopic papillectomy for early ampullary tumors: long-term results from a large multicenter prospective study. Endoscopy 2014; 46: 127-134
• 20 van der Wiel SE, Poley J-W, Koch AD. et al. Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study. Surg Endosc 2019; 33: 1180-1188
• 21 Irani S, Arai A, Ayub K. et al. Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period. Gastrointest Endosc 2009; 70: 923-932
• 22 Ödemiş B, Durak MB, Cengiz M. Endoscopic ampullectomy of benign ampullary lesions: outcomes from a single center study. Surg Laparosc Endosc Percutan Tech 2020; 30: 270-275
• 23 Klein A, Qi Z, Bahin FF. et al. Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent. Endoscopy 2018; 50: 972-983
• 24 Pérez-Cuadrado-Robles E, Piessevaux H, Moreels TG. et al. Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms. United Eur Gastroenterol J 2019; 7: 369-376
• 25 Binmoeller KF, Boaventura S, Ramsperger K. et al. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 1993; 39: 127-131
• 26 Spadaccini M, Fugazza A, Frazzoni L. et al. Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis. United Eur Gastroenterol J 2020; 8: 44-51
• 27 Winter JM, Cameron JL, Olino K. et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis. J Gastrointest Surg 2010; 14: 379-387
• 28 Patel V, Jowell P, Obando J. et al. Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy? . Endosc Int Open 2016; 4: E1313-E1318
• 29 Uchiyama Y, Imazu H, Kakutani H. et al. New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system. J Gastroenterol 2006; 41: 483-490
• 30 Park J-S, Seo D-W, Song TJ. et al. Usefulness of white-light imaging-guided narrow-band imaging for the differential diagnosis of small ampullary lesions. Gastrointest Endosc 2015; 82: 94-101
• 31 Itoi T, Tsuji S, Sofuni A. et al. A novel approach emphasizing preoperative margin enhancement of tumor of the major duodenal papilla with narrow-band imaging in comparison to indigo carmine chromoendoscopy (with videos). Gastrointest Endosc 2009; 69: 136-141
• 32 Yamaguchi K, Enjoji M, Kitamura K. Endoscopic biopsy has limited accuracy in diagnosis of ampullary tumors. Gastrointest Endosc 1990; 36: 588-592
• 33 Rodríguez C, Borda F, Elizalde I. et al. How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours?. Rev Espanola Enfermedades Dig 2002; 94: 585-592
• 34 Menzel J, Poremba C, Dietl KH. et al. Tumors of the papilla of Vater–inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol 1999; 10: 1227-1231
• 35 Elek G, Gyôri S, Tóth B. et al. Histological evaluation of preoperative biopsies from ampulla vateri. Pathol Oncol Res POR 2003; 9: 32-41
• 36 Grobmyer SR, Stasik CN, Draganov P. et al. Contemporary results with ampullectomy for 29 “benign” neoplasms of the ampulla. J Am Coll Surg 2008; 206: 466-471
• 37 Laleman W, Verreth A, Topal B. et al. Endoscopic resection of ampullary lesions: a single-center 8-year retrospective cohort study of 91 patients with long-term follow-up. Surg Endosc 2013; 27: 3865-3876
• 38 Yamamoto K, Itoi T, Sofuni A. et al. Expanding the indication of endoscopic papillectomy for T1a ampullary carcinoma. Dig Endosc 2019; 31: 188-196
• 39 Li S, Wang Z, Cai F. et al. New experience of endoscopic papillectomy for ampullary neoplasms. Surg Endosc 2019; 33: 612-619
• 40 Kim H-N, Kim KM, Shin JU. et al. Prediction of carcinoma after resection in subjects with ampullary adenomas on endoscopic biopsy. J Clin Gastroenterol 2013; 47: 346-351
• 41 Alali A, Espino A, Moris M. et al. Endoscopic resection of ampullary tumours: long-term outcomes and adverse events. J Can Assoc Gastroenterol 2020; 3: 17-25
• 42 Mehta NA, Shah RS, Yoon J. et al. Risks, benefits, and effects on management for biopsy of the papilla in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 2020;
• 43 Bourgeois N, Dunham F, Verhest A. et al. Endoscopic biopsies of the papilla of Vater at the time of endoscopic sphincterotomy: difficulties in interpretation. Gastrointest Endosc 1984; 30: 163-166
• 44 Leese T, Neoptolemos JP, West KP. et al. Tumours and pseudotumours of the region of the ampulla of Vater: an endoscopic, clinical and pathological study. Gut 1986; 27: 1186-1192
• 45 Ponchon T, Aucia N, Mitchell R. et al. Biopsies of the ampullary region in patients suspected to have sphincter of Oddi dysfunction. Gastrointest Endosc 1995; 42: 296-300
• 46 Defrain C, Chang CY, Srikureja W. et al. Cytologic features and diagnostic pitfalls of primary ampullary tumors by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2005; 105: 289-297
• 47 Ogura T, Hara K, Hijioka S. et al. Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for tumors of the ampulla of vater? An initial study. . Endosc Ultrasound 2012; 1: 84-89
• 48 Kandler J, Neuhaus H. How to approach a patient with ampullary lesion. Gastroenterology 2018; 155: 1670-1676
• 49 Zhou Y, Li D, Wu L. et al. The histopathologic type predicts survival of patients with ampullary carcinoma after resection: A meta-analysis. Pancreatology 2017; 17: 273-278
• 50 Ang DC, Shia J, Tang LH. et al. The utility of immunohistochemistry in subtyping adenocarcinoma of the ampulla of vater. Am J Surg Pathol 2014; 38: 1371-1379
• 51 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188
• 52 Gingras M-C, Covington K, Chang D. et al. Ampullary cancers harbor ELF3 tumor suppressor gene mutations and exhibit frequent WNT dysregulation. Cell Rep 2016; 14: 907-919
• 53 Perkins G, Svrcek M, Bouchet-Doumenq C. et al. Can we classify ampullary tumours better? Clinical, pathological and molecular features. Results of an AGEO study. . Br J Cancer 2019; 120: 697-702
• 54 Yasuda K, Mukai H, Cho E. et al. The use of endoscopic ultrasonography in the diagnosis and staging of carcinoma of the papilla of Vater. Endoscopy 1988; 20 (Suppl. 01) 218-222
• 55 Mukai H, Nakajima M, Yasuda K. et al. Evaluation of endoscopic ultrasonography in the pre-operative staging of carcinoma of the ampulla of Vater and common bile duct. Gastrointest Endosc 1992; 38: 676-683
• 56 Zhang QL, Nian WD, Zhang LP. et al. Endoscopic ultrasonography assessment for ampullary and bile duct malignancy. Diagn Ther Endosc 1996; 03: 35-40
• 57 Rattner DW, Fernandez-del Castillo C, Brugge WR. et al. Defining the criteria for local resection of ampullary neoplasms. Arch Surg Chic Ill 1960 1996; 131: 366-371
• 58 Tio TL, Sie LH, Kallimanis G. et al. Staging of ampullary and pancreatic carcinoma: comparison between endosonography and surgery. Gastrointest Endosc 1996; 44: 706-713
• 59 Quirk DM, Rattner DW, Fernandez-del Castillo C. et al. The use of endoscopic ultrasonography to reduce the cost of treating ampullary tumors. Gastrointest Endosc 1997; 46: 334-337
• 60 Itoh A, Goto H, Naitoh Y. et al. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 1997; 45: 251-260
• 61 Sauvanet A, Chapuis O, Hammel P. et al. Are endoscopic procedures able to predict the benignity of ampullary tumors?. Am J Surg 1997; 174: 355-358
• 62 Cannon ME, Carpenter SL, Elta GH. et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999; 50: 27-33
• 63 Kubo H, Chijiiwa Y, Akahoshi K. et al. Pre-operative staging of ampullary tumours by endoscopic ultrasound. Br J Radiol 1999; 72: 443-447
• 64 Chen CH, Tseng LJ, Yang CC. et al. Preoperative evaluation of periampullary tumors by endoscopic sonography, transabdominal sonography, and computed tomography. J Clin Ultrasound JCU 2001; 29: 313-321
• 65 Skordilis P, Mouzas IA, Dimoulios PD. et al. Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. . BMC Surg 2002; 2: 1
• 66 Chen C-H, Yang C-C, Yeh Y-H. et al. Reappraisal of endosonography of ampullary tumors: correlation with transabdominal sonography, CT, and MRI. J Clin Ultrasound JCU 2009; 37: 18-25
• 67 Artifon ELA, Couto DJ, Sakai P. et al. Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest Endosc 2009; 70: 290-296
• 68 Manta R, Conigliaro R, Castellani D. et al. Linear endoscopic ultrasonography vs magnetic resonance imaging in ampullary tumors. World J Gastroenterol 2010; 16: 5592-5597
• 69 Wee E, Lakhtakia S, Gupta R. et al. The diagnostic accuracy and strength of agreement between endoscopic ultrasound and histopathology in the staging of ampullary tumors. Indian J Gastroenterol 2012; 31: 324-332
• 70 Trikudanathan G, Njei B, Attam R. et al. Staging accuracy of ampullary tumors by endoscopic ultrasound: meta-analysis and systematic review. Dig Endosc 2014; 26: 617-626
• 71 Okano N, Igarashi Y, Hara S. et al. Endosonographic preoperative evaluation for tumors of the ampulla of vater using endoscopic ultrasonography and intraductal ultrasonography. Clin Endosc 2014; 47: 174-177
• 72 Ridtitid W, Schmidt SE, Al-Haddad MA. et al. Performance characteristics of EUS for locoregional evaluation of ampullary lesions. Gastrointest Endosc 2015; 81: 380-388
• 73 Shen Z, Munker S, Zhou B. et al. The accuracies of diagnosing pancreas divisum by magnetic resonance cholangiopancreatography and endoscopic ultrasound: a systematic review and meta-analysis. Sci Rep 2016; 6: 35389
• 74 Ito K, Fujita N, Noda Y. et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc 2007; 66: 740-747
• 75 Heinzow HS, Lenz P, Lallier S. et al. Ampulla of Vater tumors: impact of intraductal ultrasound and transpapillary endoscopic biopsies on diagnostic accuracy and therapy. Acta Gastro-Enterol Belg 2011; 74: 509-515
• 76 Meister T, Heinzow HS, Woestmeyer C. et al. Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology. World J Gastroenterol 2013; 19: 874-881
• 77 Heinzow HS, Kammerer S, Rammes C. et al. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 2014; 20: 10495-10503
• 78 Zádorová Z, Dvofák M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy 2001; 33: 345-347
• 79 Vogt M, Jakobs R, Benz C. et al. Endoscopic therapy of adenomas of the papilla of Vater. A retrospective analysis with long-term follow-up. Dig Liver Dis 2000; 32: 339-345
• 80 Catalano MF, Linder JD, Chak A. et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 2004; 59: 225-232
• 81 Jeanniard-Malet O, Caillol F, Pesenti C. et al. Short-term results of 42 endoscopic ampullectomies: a single-center experience. Scand J Gastroenterol 2011; 46: 1014-1019
• 82 Ahn D-W, Ryu JK, Kim J. et al. Endoscopic papillectomy for benign ampullary neoplasms: how can treatment outcome be predicted?. Gut Liver 2013; 7: 239-245
• 83 Attila T, Parlak E, Alper E. et al. Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study. Turk J Gastroenterol 2018; 29: 325-334
• 84 De Palma GD, Luglio G, Maione F. et al. Endoscopic snare papillectomy: a single institutional experience of a standardized technique. A retrospective cohort study. . Int J Surg Lond Engl 2015; 13: 180-183
• 85 Ridtitid W, Tan D, Schmidt SE. et al. Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc 2014; 79: 289-296
• 86 Cheng C-L, Sherman S, Fogel EL. et al. Endoscopic snare papillectomy for tumors of the duodenal papillae. Gastrointest Endosc 2004; 60: 757-764
• 87 Tsuji S, Itoi T, Sofuni A. et al. Tips and tricks in endoscopic papillectomy of ampullary tumors: single-center experience with large case series (with videos). J Hepatobiliary Pancreat Sci 2015; 22: E22-E27
• 88 Sahar N, Krishnamoorthi R, Kozarek RA. et al. Long-term outcomes of endoscopic papillectomy for ampullary adenomas. Dig Dis Sci 2020; 65: 260-268
• 89 Tringali A, Valerii G, Boškoski I. et al. Endoscopic snare papillectomy for adenoma of the ampulla of vater: Long-term results in 135 consecutive patients. Dig Liver Dis 2020; 52: 1033-1038
• 90 Lee R, Huelsen A, Gupta S. et al. Endoscopic ampullectomy for non-invasive ampullary lesions: a single-center 10-year retrospective cohort study. Surg Endosc 2021; 35: 684-692
• 91 Gracient A, Delcenserie R, Chatelain D. et al. Endoscopic or surgical ampullectomy for intramucosal ampullary tumor: the patient populations are not the same. J Visc Surg 2020; 157: 183-191
• 92 Nappo G, Gentile D, Galvanin J. et al. Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients. Surg Endosc 2020; 34: 4358-4368
• 93 Mendonça EQ, Bernardo WM, de Moura EGH . et al. Endoscopic versus surgical treatment of ampullary adenomas: a systematic review and meta-analysis. Clin Sao Paulo Braz 2016; 71: 28-35
• 94 Ceppa EP, Burbridge RA, Rialon KL. et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg 2013; 257: 315-322
• 95 Dubois M, Labgaa I, Dorta G. et al. Endoscopic and surgical ampullectomy for non-invasive ampullary tumors: Short-term outcomes. Biosci Trends 2017; 10: 507-511
• 96 Sauvanet A, Dokmak S, Cros J. et al. Surgical ampullectomy with complete resection of the common bile duct: a new procedure for radical resection of non-invasive ampulloma with biliary extension. J Gastrointest Surg 2017; 21: 1533-1539
• 97 Yamamoto K, Sofuni A, Tsuchiya T. et al. Clinical impact of piecemeal resection concerning the lateral spread of ampullary adenomas. Intern Med 2019; 58: 901-906
• 98 Yoon Y-S, Kim S-W, Park SJ. et al. Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Ann Surg 2005; 242: 92-100
• 99 Hsu H-P, Yang T-M, Hsieh Y-H. et al. Predictors for patterns of failure after pancreaticoduodenectomy in ampullary cancer. Ann Surg Oncol 2007; 14: 50-60
• 100 Lee H, Park JY, Kwon W. et al. Transduodenal ampullectomy for the treatment of early-stage ampulla of vater cancer. World J Surg 2016; 40: 967-973
• 101 Kawabata Y, Ishikawa N, Moriyama I. et al. What is an adequate surgical management for pTis and pT1 early ampullary carcinoma?. Hepatogastroenterology 2014; 61: 12-17
• 102 Yamao T, Isomoto H, Kohno S. et al. Endoscopic snare papillectomy with biliary and pancreatic stent placement for tumors of the major duodenal papilla. Surg Endosc 2010; 24: 119-124
• 103 Alvarez-Sanchez M-V, Oria I, Luna OB. et al. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?. Surg Endosc 2017; 31: 1564-1572
• 104 Yoon SM, Kim M-H, Kim MJ. et al. Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?. Gastrointest Endosc 2007; 66: 701-707
• 105 Salmi S, Ezzedine S, Vitton V. et al. Can papillary carcinomas be treated by endoscopic ampullectomy?. Surg Endosc 2012; 26: 920-925
• 106 Gao Y, Zhu Y, Huang X. et al. Transduodenal ampullectomy provides a less invasive technique to cure early ampullary cancer. BMC Surg 2016; 16: 36
• 107 Song J, Liu H, Li Z. et al. Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy. BMC Surg 2015; 15: 32
• 108 Hornick JR, Johnston FM, Simon PO. et al. A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: management and outcomes. Surgery 2011; 150: 169-176
• 109 Beger HG, Treitschke F, Gansauge F. et al. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999; 134: 526-532
• 110 Dumonceau J-M, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy 2018; 50: 910-930
• 111 Inamdar S, Slattery E, Bhalla R. et al. Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol 2016; 2: 112-117
• 112 Duan F, Cui L, Bai Y. et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging 2017; 17: 27
• 113 Moole H, Bechtold ML, Forcione D. et al. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine (Baltimore) 2017; 96: e5154
• 114 Wang K, Zhu J, Xing L. et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2016; 83: 1218-1227
• 115 Khan MA, Akbar A, Baron TH. et al. Endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. Dig Dis Sci 2016; 61: 684-703
• 116 Bishay K, Boyne D, Yaghoobi M. et al. Endoscopic ultrasound-guided transmural approach versus ERCP-guided transpapillary approach for primary decompression of malignant biliary obstruction: a meta-analysis. Endoscopy 2019; 51: 950-960
• 117 Hathorn KE, Bazarbashi AN, Sack JS. et al. EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1432-E1441
• 118 Jin Z, Wei Y, Lin H. et al. Endoscopic ultrasound-guided versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta-analysis. Dig Endosc 2020; 32: 16-26
• 119 Li D-F, Zhou C-H, Wang L-S. et al. Is ERCP-BD or EUS-BD the preferred decompression modality for malignant distal biliary obstruction? A meta-analysis of randomized controlled trials. . Rev Espanola Enfermedades Dig 2019; 111: 953-960
• 120 Logiudice FP, Bernardo WM, Galetti F. et al. Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis. World J Gastrointest Endosc 2019; 11: 281-291
• 121 Lou X, Yu D, Li J. et al. Efficacy of endoscopic ultrasound-guided and endoscopic retrograde cholangiopancreatography-guided biliary drainage for malignant biliary obstruction: a systematic review and meta-analysis. Minerva Med 2019; 110: 564-574
• 122 Miller CS, Barkun AN, Martel M. et al. Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 2019; 7: E1563-E1573
• 123 Han SY, Kim S-O, So H. et al. EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis. Sci Rep 2019; 9: 16551
• 124 Bernon MM, Shaw J, Burmeister S. et al. Distal malignant biliary obstruction: a prospective randomised trial comparing plastic and uncovered self-expanding metal stents in the palliation of symptomatic jaundice. South Afr J Surg 2018; 56: 30-34
• 125 Yuan T-W, Liu H-Q, Wang S-B. et al. Comparison of plastic stents with self-expandable metal stents in palliative treatment of malignant biliary obstruction: a meta-analysis. Eur Rev Med Pharmacol Sci 2017; 21: 2847-2857
• 126 Tringali A, Hassan C, Rota M. et al. Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy 2018; 50: 631-641
• 127 Conio M, Mangiavillano B, Caruso A. et al. Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: a randomized multicenter study. Gastrointest Endosc 2018; 88: 283-291.e3
• 128 Dhondt E, Vanlangenhove P, De Man M. et al. No advantage of expanded polytetrafluoroethylene and fluorinated ethylene propylene-covered stents over uncovered nitinol stents for percutaneous palliation of malignant infrahilar biliary obstruction: results of a single-center prospective randomized trial. J Vasc Interv Radiol JVIR 2020; 31: 82-92
• 129 Lee PJ, Podugu A, Wu D. et al. Preoperative biliary drainage in resectable pancreatic cancer: a systematic review and network meta-analysis. HPB 2018; 20: 477-486
• 130 Barauskas G, Urbonas K, Smailyte G. et al. Preoperative endoscopic biliary drainage may negatively impact survival following pancreatoduodenectomy for ampullary cancer. Dig Surg 2016; 33: 462-469
• 131 Bourgouin S, Ewald J, Mancini J. et al. Disease-free survival following resection in non-ductal periampullary cancers: A retrospective multicenter analysis. Int J Surg 2017; 42: 103-109
• 132 Wu J-M, Ho T-W, Yen H-H. et al. Endoscopic retrograde biliary drainage causes intra-abdominal abscess in pancreaticoduodenectomy patients: an important but neglected risk factor. Ann Surg Oncol 2019; 26: 1086-1092
• 133 Miura F, Sano K, Wada K. et al. Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma. Am J Surg 2017; 214: 256-261
• 134 Strom TJ, Klapman JB, Springett GM. et al. Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage. Surg Endosc 2015; 29: 3273-3281
• 135 Uemura K, Murakami Y, Satoi S. et al. Impact of preoperative biliary drainage on long-term survival in resected pancreatic ductal adenocarcinoma: a multicenter observational study. Ann Surg Oncol 2015; 22 (Suppl. 03) S1238-1246
• 136 Wang L, Lin N, Xin F. et al. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction. World J Surg Oncol 2019; 17: 116
• 137 Crippa S, Cirocchi R, Partelli S. et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol J 2016; 42: 1278-1285
• 138 Liu P, Lin H, Chen Y. et al. Comparison of metal and plastic stents for preoperative biliary drainage in resectable and borderline resectable periampullary cancer: a meta-analysis and system review. J Laparoendosc Adv Surg Tech A 2018; 28: 1074-1082
• 139 Boix J, Lorenzo-Zúñiga V, Moreno de Vega V. et al. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc 2009; 23: 45-49
• 140 Bohnacker S, Seitz U, Nguyen D. et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc 2005; 62: 551-560
• 141 Suarez AL, Coté GA, Elmunzer BJ. Adjunctive radiofrequency ablation for the endoscopic treatment of ampullary lesions with intraductal extension (with video). Endosc Int Open 2016; 4: E748-751
• 142 Rustagi T, Irani S, Reddy DN. et al. Radiofrequency ablation for intraductal extension of ampullary neoplasms. Gastrointest Endosc 2017; 86: 170-176
• 143 Camus M, Napoléon B, Vienne A. et al. Efficacy and safety of endobiliary radiofrequency ablation for the eradication of residual neoplasia after endoscopic papillectomy: a multicenter prospective study. Gastrointest Endosc 2018; 88: 511-518
• 144 Monson JR, Donohue JH, McEntee GP. et al. Radical resection for carcinoma of the ampulla of Vater. Arch Surg 1991; 126: 353-357
• 145 Desilets DJ, Dy RM, Ku PM. et al. Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications. Gastrointest Endosc 2001; 54: 202-208
• 146 Ardengh JC, Kemp R, Lima-Filho ÉR. et al. Endoscopic papillectomy: The limits of the indication, technique and results. World J Gastrointest Endosc 2015; 7: 987-994
• 147 Bassan M, Bourke M. Endoscopic ampullectomy: a practical guide. J Interv Gastroenterol 2012; 2: 23-30
• 148 Bohnacker S, Soehendra N, Maguchi H. et al. Endoscopic resection of benign tumors of the papilla of vater. Endoscopy 2006; 38: 521-525
• 149 Espinel J, Pinedo E, Ojeda V. et al. Endoscopic ampullectomy: a technical review. Rev Esp Enferm Dig 2016; 108: 271-278
• 150 Patel R, Varadarajulu S, Wilcox CM. Endoscopic ampullectomy: techniques and outcomes. J Clin Gastroenterol 2012; 46: 8-15
• 151 Han J, Kim M-H. Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc 2006; 63: 292-301
• 152 Heinzow HS, Lenz P, Lenze F. et al. Feasibility of snare papillectomy in ampulla of Vater tumors: meta-analysis and study results from a tertiary referral center. Hepatogastroenterology 2012; 59: 332-335
• 153 Ismail S, Udd M, Heikki J. et al. Endoscopic papillectomy, single-centre experience. Surg Endosc 2014; 28: 3234-3239
• 154 Ito K, Fujita N, Noda Y. et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc 2012; 24: 30-35
• 155 Menees SB, Schoenfeld P, Kim HM. et al. A survey of ampullectomy practices. World J Gastroenterol 2009; 15: 3486-3492
• 156 Hyun J, Lee T, Park J. et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc 2017; 85: 746-755
• 157 Chung KH, Lee SH, Choi JH. et al. Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity-score matching analysis. United Eur Gastroenterol J 2018; 6: 576-585
• 158 Lee SK, Kim M-H, Seo DW. et al. Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: are they necessary and safe procedures?. Gastrointest Endosc 2002; 55: 302-304
• 159 Alexander S, Bourke MJ, Williams SJ. et al. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 2009; 69: 66-73
• 160 Fanning SB, Bourke MJ, Williams SJ. et al. Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 2012; 75: 805-812
• 161 Navaneethan U, Lourdusamy D, Mehta D. et al. Endoscopic resection of large sporadic non-ampullary duodenal polyps: efficacy and long-term recurrence. Surg Endosc 2014; 28: 2616-2622
• 162 Singh A, Siddiqui UD, Konda VJ. et al. Safety and efficacy of EMR for sporadic, nonampullary duodenal adenomas: a single U.S. center experience (with video). Gastrointest Endosc 2016; 84: 700-708
• 163 Hoteya S, Furuhata T, Takahito T. et al. Endoscopic submucosal dissection and endoscopic mucosal resection for non-ampullary superficial duodenal tumor. Digestion 2017; 95: 36-42
• 164 Bartel MJ, Puri R, Brahmbhatt B. et al. Endoscopic and surgical management of nonampullary duodenal neoplasms. Surg Endosc 2018; 32: 2859-2869
• 165 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 166 Klein A, Nayyar D, Bahin FF. et al. Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events and long-term outcomes. Gastrointest Endosc 2016; 84: 688-696
• 167 Klein A, Tutticci N, Bourke MJ. Endoscopic resection of advanced and laterally spreading duodenal papillary tumors. Dig Endosc 2016; 28: 121-130
• 168 Minami K, Iwasaki E, Fukuhara S. et al. Electric endocut and autocut resection for endoscopic papillectomy: a systematic review. Intern Med 2019; 58: 2767-2772
• 169 Iwasaki E, Minami K, Itoi T. et al. Impact of electrical pulse cut mode during endoscopic papillectomy: Pilot randomized clinical trial. Dig Endosc 2020; 32: 127-135
• 170 El Hajj II, Coté GA. Endoscopic diagnosis and management of ampullary lesions. Gastrointest Endosc Clin N Am 2013; 23: 95-109
• 171 Norton ID, Gostout CJ, Baron TH. et al. Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc 2002; 56: 239-243
• 172 Nam K, Song TJ, Kim RE. et al. Usefulness of argon plasma coagulation ablation subsequent to endoscopic snare papillectomy for ampullary adenoma. Dig Endosc 2018; 30: 485-492
• 173 Yang JK, Hyun JJ, Lee TH. et al. Can prophylactic argon plasma coagulation reduce delayed post-papillectomy bleeding? A prospective multicenter trial.. J Gastroenterol Hepatol 2021; 36: 467-473
• 174 Kagawa K, Kubota K, Kurita Y. et al. Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study. J Gastroenterol Hepatol 2020; 35: 374-379
• 175 Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc 2005; 62: 367-370
• 176 Wang Y, Qi M, Hao Y. et al. The efficacy of prophylactic pancreatic stents against complications of post-endoscopic papillectomy or endoscopic ampullectomy: a systematic review and meta-analysis. Ther Adv Gastroenterol 2019;
• 177 Mazaki T, Mado K, Masuda H. et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol 2014; 49: 343-355
• 178 Patai Á, Solymosi N, Mohácsi L. et al. Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointest Endosc 2017; 85: 1144-1156.e1
• 179 Radadiya D, Devani K, Arora S. et al. Peri-procedural aggressive hydration for post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis prophylaxsis: meta-analysis of randomized controlled trials. Pancreatology 2019; 19: 819-827
• 180 Wang G, Xiao G, Xu L. et al. Effect of somatostatin on prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia: A systematic review and meta-analysis. Pancreatology 2018; 18: 370-378
• 181 Ding J, Jin X, Pan Y. et al. Glyceryl trinitrate for prevention of post-ERCP pancreatitis and improve the rate of cannulation: a meta-analysis of prospective, randomized, controlled trials. PloS One 2013; 8: e75645
• 182 Dumonceau J-M, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-149
• 183 Choksi N, Elmunzer BJ, Stidham RW. et al. Cold snare piecemeal resection of colonic and duodenal polyps ≥ 1 cm. Endosc Int Open 2015; 3: E508-513
• 184 Mutignani M, Seerden T, Tringali A. et al. Endoscopic hemostasis with fibrin glue for refractory postsphincterotomy and postpapillectomy bleeding. Gastrointest Endosc 2010; 71: 856-860
• 185 Sakai A, Tsujimae M, Masuda A. et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol 2019; 25: 1387-1397
• 186 Hassan C, Ponchon T, Bisschops R. et al. European Society of Gastrointestinal Endoscopy (ESGE) Publications Policy – Update 2020. Endoscopy 2020; 52: 123-126