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Endoscopic papillectomy (EP) is an established minimally invasive treatment for ampullary adenoma; however, treatment selection in older patients requires careful consideration of oncologic benefit, procedural risk, geriatric vulnerability, and life expectancy. This review outlines key geriatric assessment tools and evaluates the safety, prognosis, and treatment selection of endoscopic and surgical approaches for ampullary tumors in older patients. With appropriate selection, short\u2010term EP outcomes appear comparable between older and younger patients. However, EP can cause fatal adverse events and often requires long\u2010term surveillance or retreatment. In older patients, long\u2010term prognosis is strongly influenced by comorbidity burden and competing mortality, with a high age\u2010adjusted Charlson Comorbidity Index associated with poorer overall survival. Natural history data from familial adenomatous polyposis and colorectal adenomas provide an indirect time\u2010axis framework for considering surveillance in selected high\u2010risk patients. Management of ampullary tumors in older patients should be guided by integrated assessment of oncologic and geriatric factors rather than chronological age alone. Standardized geriatric assessment may help identify patients best suited for intervention or surveillance. Prospective studies incorporating functional outcomes, quality of life, and treatment\u2010related mortality are needed to support evidence\u2010based decision\u2010making.<\/jats:p>","DOI":"10.1111\/den.70250","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:22:30Z","timestamp":1785324150000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic Papillectomy for Ampullary Tumors in Older Patients: Balancing Oncologic Benefit and Geriatric Risk"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1658-7304","authenticated-orcid":false,"given":"Yoshihisa","family":"Takada","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine  Nagoya Aichi Japan"},{"name":"Department of Clinical Research Education Nagoya University Graduate School of Medicine  Nagoya Aichi 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