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

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VANBIERVLIET G. STRIJKER M. ARVANITAKIS M. AELVOET A. ARNELO U. BEYNA T. BUSCH O. DEPREZ P. H. KUNOVSKÝ Lumír LARGHI A. MANES G. MOSS A. NAPOLEON B. NAYAR M. PEREZ-CUADRADO-ROBLES E. SEEWALD S. BARTHET M. VAN HOOFT J. E.

Rok publikování 2021
Druh Článek v odborném periodiku
Časopis / Zdroj Endoscopy
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www https://www.esge.com/endoscopic-management-of-ampullary-tumors-european-society-of-gastrointestinal-endoscopy-esge-guideline/
Doi http://dx.doi.org/10.1055/a-1397-3198
Klíčová slova ampullary tumors; endoscopic management
Popis 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 20-30mm 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 >4cm), and in the case of intraductal involvement (of >20mm). 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.

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