2015 ASGE指南：消化内镜在壶腹及十二指肠腺瘤中的作用

Adenomas of the major duodenal papilla, also known as ampullary adenomas, can occur sporadically or in the context of genetic syndromes such as familial adenomatous polyposis (FAP). These lesions have the potential to undergo malignant transformation to ampullary cancer, and their clinical significance extends beyond the need to treat any associated symptoms. Endoscopic screening and surveillance of high-risk patients, such as those with FAP, also has led to increasing recognition of ampullary adenomas.  Ampullary adenomas have historically been treated surgically. Surgical options have traditionally included pancreaticoduodenectomy (the Whipple procedure) or transduodenal ampullectomy (which can occasionally leave behind residual adenomatous tissue). Although surgical management often allows complete removal, it is associated with morbidity, including postoperative anastomotic dehiscence and fistulae in up to 9% and 14% of patients, respectively, and mortality rates ranging from 1% to 9%. Endoscopic approaches to the evaluation and treatment of ampullary adenomas have developed considerably in recent years, and these techniques now represent a viable alternative to surgical therapy in select cases.  The management of ampullary adenomas in the setting of FAP has been addressed in a previous American Society for Gastrointestinal Endoscopy (ASGE) guideline.