Lecture : Endoscopic papillectomy/ampullectomy Tae Hoon Lee, MD, PhD Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan Hospital, Cheonan, Korea Correspondence to: Tae Hoon Lee, MD, PhD Division of Gastroenterology, Department of Internal Medicine Soonchunhyang University School of Medicine, Cheonan Hospital 23-20 Bongmyung-dong, Cheonan-si, Chungcheongnam-do, 330-721, Korea Phone (Office): +82-41-570-3662 Facsimile: +82-10-574-5762 E-mail: thlee9@schmc.ac.kr/ taewoolee9@gmail.com Among the many types of tumor that arise from the ampulla of Vater (AoV), the most frequently encountered are ampullary adenomas. Ampullary adenomas are precancerous lesions as they are considered to follow the adenoma–carcinoma sequence as do adenomas of the colon. Therefore, complete resection of an ampullary adenoma is desirable. Traditionally, surgical management by either pancreaticoduodenectomy or duodenostomy and excision has been the standard treatment modality for ampullary adenomas. However, pancreaticoduodenectomy is a major operation that is associated with mortality and morbidity. Although local excision is associated with lower mortality and morbidity rates compared with pancreaticoduodenectomy, it could still be too invasive for treating relatively small ampullary adenomas. Surgical ampullectomy is less invasive and may be a good option for the T1 cancer without lymph node metastasis. Compared with endoscopic papillectomy, it provides more deep and complete resection and saves separate ducts. As an alternative, endoscopic papillectomy using a snare is currently accepted as an effective first-line therapy for resecting ampullary tumors when appropriate indications are met. Benign adenoma from low-grade to high-grade dysplasia is a well-known indication for endoscopic papillectomy. However, there are still some debated regarding indication, endoscopic techniques, prevention of adverse events, and surveillance. Endoscopic papillectomy can be a primary effective therapy for ampullary adenoma including high-grade dysplasia and Tis. T1 cancer can be adapted selectively. However, exact preoperative evaluation of T1 is now limited. Endoscopic technique should be also standardized for complete resection and to minimize serious adverse events such as pancreatitis. Minimally invasive surgery and endoscopic approach should be a complementary method each other according to the status of patients. In this topic, we will discuss on these debates, and also suggests the optimal range of endoscopic papillectomy, especially in high-grade dysplasia, carcinoma in situ, and T1 cancer. References 1. Han J, Kim MH. Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc 2006;63:292-301. 2. Hyun JJ, Lee TH, Park JS, et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc 2017;85:746-755. 3. Moon JH, Choi HJ, Lee YN. Current Status of Endoscopic Papillectomy for Ampullary Tumors. Gut and Liver 2014;8:598-604. 4. Yang JK, Hyun JJ, Lee TH, et al. Can prophylactic argon plasma coagulation reduce delayed post-papillectomy bleeding? A prospective multicenter trial. J Gastroenterol Hepatol 2020 (in press).