Combined Excision and Ablation of Ampullary Tumors with Biliary or Pancreatic Intraductal Extension is Effective Even in Malignant Neoplasms

Background: The feasibility and outcome of endoscopic resection in ampullary tumors with intraductal growth remains unclear.

Objective: To assess the safety, feasibility and outcomes of these patients treated by thermal ablation.

Methods: Retrospective observational study. All consecutive patients who underwent an endoscopic snare papillectomy with a 6-month minimum follow-up were included. Ablation was performed with cystotomes and soft/forced coagulation. Successful endoscopic treatment was defined as no adenomatous residual tissue or recurrence observed at follow-up.

Results: Of 86 patients presenting with an ampullary tumor, 73 (58 ± 14 years old, 49% men, 34% familial adenomatous polyposis) (median tumor size: 20 mm, range: 8-80) were included. En bloc and curative resection rates were achieved in 46.6% and 83.6%, respectively.Intraductal ingrowth was seen in 18 (24.7%) patients and histologically confirmed in 12 (16.4%). Intraductal ablation achieved a 100% success rate, with a 20-month median follow-up. Most of these patients had malignant forms ( = 8, 66.7%), with a higher adenocarcinoma rate (33.3% versus 3.3%,  = 0.001) compared to extraductal tumors.Overall, there was a 20.5% complication rate with no significant differences between both groups ( = 0.676).

Conclusions: Intraductal ablation achieves a high therapeutic success rate in ampullary tumors with ≤20 mm ductal extension, even in malignant forms or biliary and pancreatic involvement. The technique is feasible, cheap and safe and may avoid major surgery.