{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T23:56:04Z","timestamp":1769644564409,"version":"3.49.0"},"reference-count":26,"publisher":"Rambam Health Corporation","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rambam Maimonides Med J"],"abstract":"<jats:p>Background: Ampullary neuroendocrine tumors (NETs) are extremely rare, representing 0.3%\u20131% of gastrointestinal NETs and less than 2% of periampullary cancers. Due to their rarity, there is limited data on their natural history, management, and outcomes. Current European Neuroendocrine Tumor Society guidelines (2023) recommend pancreaticoduodenectomy (PD) as the standard treatment. However, this approach is invasive and associated with high morbidity and mortality. Emerging evidence suggests that endoscopic papillectomy (EP) could be a viable alternative in selected cases. This retrospective multicenter study aimed to evaluate the feasibility and outcomes of endoscopic resection for ampullary NETs.\nMethods: This retrospective case series included 14 patients who underwent EP for ampullary NETs between 2011 and 2022 across three Italian tertiary centers. Pre-procedural evaluation was performed following European Society of Gastrointestinal Endoscopy guidelines. Endoscopic papillectomy was performed under monitored sedation, using standard snares for en bloc resection. Follow-up endoscopy was conducted at a median of 3 months. Primary outcomes included complete resection (R0) and recurrence rates; secondary outcomes focused on adverse events.\nResults: Fourteen patients (median age: 62.5 years; 50% male) were included. Median tumor size was 18 mm. In 12 out of 14 cases, ampullary NETs were diagnosed only after endoscopic resection. Post-resection histology identified 8 G1 NETs (Ki-67 1%) and 6 G2 NETs (Ki-67 5%). Complete resection was achieved in 11 cases (78.6%). Among 3 incomplete resections, 2 were managed surgically, while 1 was followed up without recurrence. Residual disease was detected in 3 patients: 2 were managed endoscopically, and 1 required surgery. No recurrences occurred during a median follow-up of 14.5 months. Adverse events occurred in 42.9% of patients, including 5 cases of bleeding and 1 case of mild pancreatitis, all resolved without major sequelae. Median hospital stay was 2.5 days.\nConclusions: Our findings suggest that EP offers a promising alternative to surgery in selected patients with ampullary NETs. Endoscopic resection was associated with high rates of R0 and favorable short-term outcomes, with effective endoscopic management of residual disease and procedure-related adverse events. Consistent post-procedural surveillance remains essential to detect residual or recurrent disease. Larger prospective studies are warranted to refine patient selection criteria, optimize protocols, and establish the long-term efficacy.<\/jats:p>","DOI":"10.5041\/rmmj.10562","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:17:48Z","timestamp":1769599068000},"page":"e0001","source":"Crossref","is-referenced-by-count":0,"title":["Ampullary Neuroendocrine Tumors: Multicenter Experience and Emerging Perspectives on Endoscopic Treatment"],"prefix":"10.5041","volume":"17","author":[{"name":"Digestive Endoscopy Unit, AOU San Giovanni e Ruggi-Fucito Unit, Salerno, 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Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Forti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Pugliese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Cintolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Bonato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Bravo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Palermo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Gallo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ceclia","family":"Binda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Gastroenterology and Digestive Endoscopy Unit, Forl\u00ec-Cesena Hospitals, Romagna, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Zulli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, AOU San Giovanni e Ruggi-Fucito Unit, Salerno, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piera","family":"Zaccari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Mariani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armando","family":"Gabbrielli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, Verona, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Arcidiacono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimiliano","family":"Mutignani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2983","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","first-page":"2369","DOI":"10.2169\/internalmedicine.4568-20","article-title":"Three cases of ampullary neuroendocrine tumor treated by endoscopic papillectomy: a case report and literature review","volume":"59","author":"Shimai","year":"2020","unstructured":"1. Shimai S, Yamamoto K, Sofuni A, et al. Three cases of ampullary neuroendocrine tumor treated by endoscopic papillectomy: a case report and literature review. Intern Med 2020;59:2369-74.","journal-title":"Intern Med"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"2. Panzuto F, Ramage J, Pritchard DM, et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastroduodenal neuroendocrine tumours (NETS) G1-G3. J Neuroendocrinol 2023;35: e13306.","DOI":"10.1111\/jne.13306"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"8318","DOI":"10.1245\/s10434-021-10371-w","article-title":"Ampullary neuroendocrine tumors: insight into a rare histology","volume":"28","author":"Ruff","year":"2021","unstructured":"3. Ruff SM, Standring O, Wu G, et al. Ampullary neuroendocrine tumors: insight into a rare histology. 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Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and Euro-pean Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021;7:1611-28.","journal-title":"Gut"},{"key":"ref6","unstructured":"7. Brierley JD, Gospodarowicz MK, Wittekind C, eds. TNM Classification of Malignant Tumours [Internet]. 8th edition. Chichester, West Sussex, UK: Wiley-Blackwell; 2017. Available at: https:\/\/research.ebsco.com\/linkprocessor\/plink?id=a2f9b94b-25ef-33e6-907d-b13f01094ce7 (accessed December 9, 2024)."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","unstructured":"8. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. 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J Hepatobiliary Pancreat Sci 2018;25:17-30.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3687","DOI":"10.3748\/wjg.v22.i13.3687","article-title":"Ampullary neuroendocrine tumor diagnosed by endoscopic papillectomy in previously confirmed ampullary adenoma","volume":"22","author":"Lee","year":"2016","unstructured":"11. Lee SH, Lee TH, Jang SH, et al. Ampullary neuroendocrine tumor diagnosed by endoscopic papillectomy in previously confirmed ampullary adenoma. World J Gastroenterol 2016;22:3687.","journal-title":"World J Gastroenterol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1001\/archsurg.2009.80","article-title":"Neuroendocrine tumors of the ampulla of Vater: biological behavior and surgical management","volume":"144","author":"Carter","year":"2009","unstructured":"12. Carter JT, Grenert JP, Rubenstein L, Stewart L, Way LW. Neuroendocrine tumors of the ampulla of Vater: biological behavior and surgical management. Arch Surg 2009;144:527-31.","journal-title":"Arch Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1007\/s11605-007-0389-3","article-title":"Radical surgical resection for carcinoid tumors of the ampulla","volume":"12","author":"Hwang","year":"2008","unstructured":"13. Hwang S, Lee S-G, Lee Y-J, et al. Radical surgical resection for carcinoid tumors of the ampulla. J Gastrointest Surg 2008;12:713-17.","journal-title":"J Gastrointest Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1111\/j.1440-1746.2005.03744.x","article-title":"Carcinoid of the ampulla of Vater","volume":"20","author":"Hartel","year":"2005","unstructured":"14. Hartel M, Wente MN, Sido B, Friess H, B\u00fcchler MW. Carcinoid of the ampulla of Vater. J Gastroenterol Hepatol 2005;20:676-81.","journal-title":"J Gastroenterol Hepatol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/S2468-1253(21)00054-6","article-title":"Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, ran-domised controlled trial","volume":"6","author":"Wang","year":"2021","unstructured":"15. Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, ran-domised controlled trial. 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Cancers (Basel) 2021;13:2448.","journal-title":"Cancers (Basel)"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1177\/2050640619868367","article-title":"Endoscopic papillectomy for neoplastic ampullary lesions: a systematic review with pooled analysis","volume":"8","author":"Spadaccini","year":"2020","unstructured":"24. Spadaccini M, Fugazza A, Frazzoni L, et al. Endoscopic papillectomy for neoplastic ampullary lesions: a systematic review with pooled analysis. United European Gastroenterol J 2020;8:44-51.","journal-title":"United European Gastroenterol J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.gie.2024.02.023","article-title":"Ampullary neuroendocrine tumor: endoscopic papillectomy, an effective and safe treatment","volume":"100","author":"Ord\u00f3\u00f1ez-V\u00e1zquez","year":"2024","unstructured":"25. Ord\u00f3\u00f1ez-V\u00e1zquez AL, Lizardi-Cervera J, Ju\u00e1rez-Hern\u00e1ndez E, Uribe M, L\u00f3pez-M\u00e9ndez I. Ampullary neuroendocrine tumor: endoscopic papillectomy, an effective and safe treatment. Gastrointest Endosc 2024;100:338-9.","journal-title":"Gastrointest Endosc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1007\/s12328-020-01212-6","article-title":"Endoscopic papillectomy for an ampullary neuroendocrine tumor","volume":"13","author":"Shiratori","year":"2020","unstructured":"26. Shiratori Y, Nakamura K, Suzuki K, Fukuda K. Endoscopic papillectomy for an ampullary neuroendocrine tumor. Clin J Gastroenterol 2020;13:1144-9.","journal-title":"Clin J Gastroenterol"}],"container-title":["Rambam Maimonides Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.rmmj.org.il\/userimages\/3383\/1\/PublishFiles\/4113Article.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:28:50Z","timestamp":1769599730000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.rmmj.org.il\/issues\/69\/articles\/4113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,28]]}},"URL":"https:\/\/doi.org\/10.5041\/rmmj.10562","relation":{},"ISSN":["2076-9172"],"issn-type":[{"value":"2076-9172","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]}}}