Ampullary neuroendocrine tumor: endoscopic papillectomy, an effective and safe treatment.

Competing Interests: Disclosure All authors disclosed no financial relationships. Commentary In this case, authors describe a successful endoscopic papillectomy for the management of ampullary neuroendocrine tumor (NET). Duodenal NETs are uncommon. with a prevalence of 2.6% of all NETs. Ampullary NETs are exceedingly rare, with a <0.3% incidence of all GI NETs. Ampullary NET has an aggressive nature by default, with a higher tendency for metastasis regardless of tumor size. As such, it is essential to thoroughly assess patients with ampullary NETs for local and distant metastasis before endoscopic resection. Patients with ampullary NETs that are well differentiated and low grade, without involvement of the pancreatic or bile duct, and without peritoneal lymphadenopathy or distant metastasis, are ideal candidates for endoscopic resection. Although endoscopic papillectomy is an excellent alternative for pancreaticoduodenectomy, it is associated with a higher risk of pancreatitis. The risk of postprocedure pancreatitis is substantial, ranging between 6% and 58% in published reports. This risk can be potentially decreased with prophylactic placement of biliary and pancreatic stents. In consideration of the aggressive naure of these tumors, close surveillance after resection with serial endoscopy and radiologic imaging is recommended. Tara Keihanian, MD, MPH, Assistant Professor, Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA. Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points