Diagnosis, Staging and Treatment Strategies for Ampullary Neoplasm

Ampullary neoplasm is originated from the mucosal lining of ampulla of Vater which might involve the distal part of bile duct and pancreatic duct. The diagnosis could be made based on the finding of ampullary lesion either by endoscopy or cross sectional imaging. Endoscopic ultrasound (EUS) has an important role to determine the local extension. In T1 lesion, EUS provided  77%sensitivity and 78% specificity, while Computed Tomography (CT) and Magnetic resonance imaging (MRI) provide information of distance metastasis. EUS is also useful to determine regional lymph node metastasis and allow tissue sampling with 70% sensitivity and 74% specificity The role of pre-operative biliary drainage should be carefully considered, as it associated with increased peri-operative complications and worsening long term outcome.
The treatment for ampullary carcinoma range from endoscopic resection, surgical ampullectomy or pancreaticoduodenectomy depends on the local extension into the biliary of pancreatic system. Endoscopic resection ranged from simple ampullectomy to hybrid endoscopic submucosal dissection and papillectomy in laterally spreading lesion. Endoscopic ablation could be performed in case of positive resected margin or recurrence.