What is ERCP with Ampullectomy?

What is ERCP with Ampullectomy?

Endoscopic ampullectomy is a minimally invasive method of treating superficial lesions of the ampulla of Vater. With careful patient selection and lesion assessment it is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention.

Is ampullary adenoma malignant?

Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often asymptomatic. It is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and surveillance.

What is an Ampullectomy?

An ampullectomy is a surgical procedure that is used to treat cancers of the hepatopancreatic duct (ampullary adenomas), small neuroendocrine tumors that develop in the ampulla of Vater and certain noncancerous conditions, such as inflammatory stenosis.

What is Ampullary polyp?

The ampulla, or ampulla of vater, is where the pancreatic duct and bile duct join together to drain into the duodenum, which is the first part of the small intestine. A polyp of the ampulla starts out benign but can turn into cancer of the ampulla as it grows.

What is an Ampullary mass?

Ampullary (AM-poo-la-ree) cancer is a rare cancer that forms in an area of your digestive system called the ampulla of Vater. The ampulla of Vater is located where your bile duct and pancreatic duct join and empty into your small intestine.

How is ampullary carcinoma diagnosed?

Endoscopic retrograde cholangiopancreatography (ERCP). A biopsy is the only way to confirm this cancer. Small tissue samples are removed and checked in a lab to find out the type of cancer cells present. After a diagnosis of ampullary cancer, you’ll likely need more tests.

Can the Ampulla be removed?

An ampullectomy is the surgical removal of the entire ampulla of Vater. The ampulla of Vater or ampulla is the small projection into the duodenum through which bile and pancreatic secretions flow to mix with food for digestion. Ampullectomy can be performed as: Open surgery.

Is chemo necessary after Whipple surgery?

You should be offered chemotherapy after surgery (such as the Whipple’s procedure) to try to reduce the chances of the cancer coming back. Gemcitabine with capecitabine (GemCap) is used most often after surgery.

What is the most common complication of ERCP?

Pancreatitis (inflammation of the pancreas) is the most frequent complication, occurring in about 3 to 5 percent of people undergoing ERCP. When it occurs, it is usually mild, causing abdominal pain and nausea, which resolve after a few days in the hospital.

When to use endoscopic therapy for ampullary adenoma?

ENDOSCOPIC THERAPY. Therefore, the authors concluded that endoscopic resection is appropriate management for ampullary adenomas with HGD. Other investigators have advocated endoscopic resection for HGD if the tumor is only extraductal, and in situations where intraductal growth is less than 1 cm [ 45 ].

When does an endoscopic ampullectomy need to be performed?

Ampullectomy should only commence once complete lesion assessment has been completed. The duodenoscope should be in stable position with en face view of the ampulla. For an ampullary lesion smaller than 20mm, en bloc resection should be performed.

Are there any side effects of an endoscopic ampullectomy?

However, adverse events such as bleeding, pancreatitis and perforation, are not uncommon, and at times may be severe. Comprehensive pre-resection evaluation, a meticulous technique with a side viewing endoscope, and experience with management of complications (mainly bleeding), are crucial to ensure a safe and adequate resection.

What kind of lesion is an en-bloc ampullectomy?

A smooth elevated lesion with a small amount of granular tissue at the lateral edge (A). Complete en-bloc ampullectomy (B, C). Papillary mechanism evident on undersurface of resected specimen (D). Umbilicated lesions are uncommon.