Management of periampullary adenoma

The periampullary region is the most common site of adenomatous change in t he small bowel, particularly in patients with familial adenomatous polyposi s (FAP) syndromes. These lesions have been shown to progress to malignancy in a manor analogous to colonic polyps. Following colectomy, the periampull ary region is the commonest site of gastrointestinal malignancy in FAP pati ents. The periampullary region is within easy reach of forward- and side-vi ewing endoscopes and therefore endoscopic surveillance in FAP patients is b oth easy and prudent. Furthermore, there is accumulating evidence that endo scopic resection and/or ablation are the treatment of choice far periampull ary adenomas, However, the optimal timing of surveillance and best methods of ablation remain to be determined. This paper reviews the literature on t he endoscopic management of periampullary adenoma as well as outlining our current approach to this challenging problem.