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Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
- Source :
- Endoscopy, Vol. 53, no.4, p. 429-448 (2021), Endoscopy. GEORG THIEME VERLAG KG, Endoscopy
- Publication Year :
- 2021
-
Abstract
- Main Recommendations1 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.
- Subjects :
- Endoscopic ultrasound
medicine.medical_specialty
Ampulla of Vater
Adenoma
Common Bile Duct Neoplasms
Endoscopy, Gastrointestinal
03 medical and health sciences
0302 clinical medicine
Duodenal Neoplasms
medicine
Humans
Duodenoscopy
Pancreatic duct
Magnetic resonance cholangiopancreatography
medicine.diagnostic_test
business.industry
Ampullectomy
General surgery
Gastroenterology
Pancreatic Ducts
Guideline
medicine.disease
3. Good health
medicine.anatomical_structure
030220 oncology & carcinogenesis
Pancreatitis
030211 gastroenterology & hepatology
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 14388812
- Volume :
- 53
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Endoscopy
- Accession number :
- edsair.doi.dedup.....5a37a091d4c78720503cf8cb106bf443