Vaterian ampulloma: a review of the literature

Le résumé fourni par la source

Vaterian ampulloma is a rare entity encompassing benign and malignant tumors of the ampulla of Vater. It is usually discovered by accident but may cause biliary symptoms in advanced forms. In this context, preoperative biliary drainage should be avoided and reserved for septic or highly symptomatic obstruction, or in case of delayed surgery. Compared to other periampullary cancers, a malignant ampulla tumor has a better prognosis as it can often be curatively treated. However, this prognosis is negatively impacted by the presence of lymph node involvement. Any therapeutic decision must be preceded by a histological confirmation that may require iterative endoscopic biopsies. Knowledge of the intestinal, biliopancreatic, or mixed histological subtype is an important issue in the assessment and follow-up of ampullary tumors because of its prognostic impact. Biliary and pancreatic MRI and EUS are essential for the initial staging, and for detecting intraductal extension, which influences the selection of the appropriate treatment. The management of Vaterian ampullomas has been the focus of recent recommendations published in 2021 by the ESGE. In accordance with these recommendations, endoscopic papillectomy is indicated for the treatment of benign ampullomas of less than 3 cm because of its efficacy and safety. It can be complemented by endobiliary ablation techniques in the presence of intraductal extension of less than 2 cm. Transduodenal ampullectomy is the best alternative for the resection of benign lesions that endoscopic treatment cannot reach. On the other hand, malignant lesions require cephalic duodenopancreatectomy, which has a substantial morbidity and mortality rate. After an ampullectomy, close endoscopic monitoring with systematic biopsies should be performed for a period of at least five years.

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