Endoscopic papillectomy: Is there room for this procedure in clinical practice?

It has been 20 years since the development of endoscopic papillectomy (snare excision of the papilla of Vater). The accepted indication for this procedure is adenoma of the duodenal papilla. As for the evaluation of tumor extent, there is room for improvement of the diagnostic accuracy. Due to the high incidence of coexistent cancer detected by histological examination of surgically resected specimens in biopsy‐proven adenoma of the papilla of Vater, ablation techniques should essentially be avoided in order to preserve a specimen that is amenable to reliable histological examination. Otherwise, there may be a risk of retained coexistent cancer. It is not always possible to leave a safety margin when removing a tumor of the papilla of Vater by the snare excision technique and careful follow up is mandatory after the treatment. Consensus has not been reached as to the interval and the method of biopsy during follow up. When endoscopic biopsy from the site of the papilla of Vater at follow‐up endoscopy proves malignancy, the remnant needs to be resected surgically. An adequate follow‐up interval should be determined before this technique is established as the treatment of choice for ampullary tumors.