Krishnavel V. Chathadi, MD, Director of Endoscopic Services for Gastroenterology, Advanced Therapeutic Endoscopy, Henry Ford Health System, in Detroit, Michigan, USA, discusses this update to an ASGE document, “The role of endoscopy in ampullary and duodenal adenomas.”
This document focuses on the role of endoscopy in the evaluation and management of sporadic ampullary and duodenal adenomas.
There is increasing recognition of ampullary and duodenal adenomas. Ampullary adenomas have historically been treated surgically. While surgical management often allows complete removal, it is more invasive and can be associated with significant morbidity and mortality. 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.
This document discusses the specifics of endoscopic evaluation prior to endoscopic therapy such as biopsy techniques to increase the yield of a conclusive diagnosis and to be aware of endoscopic features that might suggest underlying malignancy since these patients may be better served by surgical resection even in the absence of malignancy on endoscopic biopsies. The role of EUS, IDUS, and ERCP in pre-resecton evaluation is also discussed in detail. The section on the review of endoscopic techniques will be particularly useful for endoscopists as it details the developments in recent years including measures to decrease the risk of adverse events. The clinical success of endoscopic therapy is also discussed along with surveillance for residual and recurrent neoplastic tissue.
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