Adenocarcinoma of Papilla of Vater (5 of 5)

Benign tumors of the ampulla of Vater, or major duodenal papilla, can be treated with endoscopic resection termed papillectomy or ampullectomy with or without adjunctive ablative therapy. Ampullary adenomas occur in 0.04 to 0.12 % of the general population and in 50% to 100% of persons with familial adenomatous polyposis (FAP) These lesions can progress through an adenoma-carcinoma sequence, as do colorectal adenomas. Ampullary carcinomas are a frequent cause of death in persons with FAP. Pancreaticoduodenectomy or local surgical resection have been the traditional treatment. However, perioperative mortality occurs in 4% to 15% and morbidity in up to 50% following pancreaticoduodenectomy. Local resection has a morbidity rate of 19% to 25% with recurrence in up to 32% at 5 years. Endoscopic therapy entails snare resection of ampullary adenomas with or without ablation with ionized argon coagulation, bipolar or heat probe, or Nd:YAG laser. Photodynamic therapy has also been used. Frequently, a combination of mechanical and thermal therapy is necessary and there is no universally accepted technique.