This AGA expert review provides best practice guidance on the endoscopic assessment, resection, and surveillance of ampullary neoplasms, covering biopsy technique, staging, papillectomy indications and contraindications, complication prevention, and post-resection follow-up.
15 Best Practice Advice statements were issued; key thresholds include ≥6 biopsies per lesion (20–40% harbor occult malignancy), en bloc resection for amenable lesions <4–5 cm with ≤1 cm intraductal extension, and surveillance starting at 3 months then 6, 12 months, and annually for ≥5 years. Ampullary cancer carries a 5-year survival of 20–75% depending on stage.
No systematic review was performed, so statements carry no formal evidence-quality ratings or strength-of-recommendation grading. Guidance is based on published literature synthesis and expert opinion, limiting reproducibility and generalizability.
Use a side-viewing duodenoscope with ≥6 targeted biopsies and EUS staging before deciding on endoscopic papillectomy; employ prophylactic pancreatic duct stenting, rectal NSAIDs, and lactated Ringer's hydration to reduce post-procedure pancreatitis. Refer complex cases (high-grade dysplasia, incomplete resection, suspected malignancy) to a multidisciplinary team.
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