Endoscopic treatment of ampullary neoplasms

The past decade has witnessed the acceptance of endoscopic ampulletomy as an effective technique in the management of non-invasive ampullary neoplasms. The ideal lesion should be smaller than 3cm and not extend into the biliary or pancreatic ducts. Endoscopic ultrasonography is helpful in excluding invasion prior to resection. Snare resection can be combined with thermal techniques of fulguration to improve success rates. Pancreatic stent placement has led to lower rates of post-ampullectomy pancreatitis, the major complication of the procedure. Performed in endoscopic centers of expertise, endoscopic ampullectomy constitutes a less morbid alternative to traditional surgical approaches toward ampullary neoplasms.