Endoscopic Papillectomy Is Effective and Safe for Ampullary Neuroendocrine Tumors: A Comprehensive Review of the Available Literature

Background and Aims: Ampullary neuroendocrine tumors (NETs) are exceedingly rare, accounting for less than 1% of gastrointestinal NETs. Historically, surgery has been the treatment of choice but is associated with high morbidity and mortality rates. Endoscopic papillectomy (EP) has been used as a treatment option for ampullary NETs. However, data on the outcomes of EP in ampullary NETs are scarce. We conducted a comprehensive review of the available literature to evaluate the efficacy and safety of EP in managing ampullary NETs. Methods: We conducted a comprehensive literature search of the MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language that addressed outcomes of EP for ampullary NETs through November 2021. The primary outcome was the rate of complete histological resection (R0). Other outcomes included rates of technical success, recurrence rates, and adverse events. Results: We identified 962 articles on the initial search. Fifteen studies with 28 patients were included. There were 13 males, and the median age was 58 years (45-77). Biopsies before EP showed NETs in 24 and adenoma in 2, and no biopsies were performed in 2 patients. Post-EP histopathology revealed NETs in all patients. Lesion size ranged from 2 to 25 mm. The method of resection was snare polypectomy (N = 19), endoscopic submucosal dissection (N = 1), and sphincterotomy with tumor suctioning (N = 1). Reported adverse events included delayed bleeding (N = 1), pancreatitis (N = 1), and duodenal perforation (N = 1). R0 resection was reported in 20 patients, positive margins were reported in 3 patients, and R status was not reported in 5 patients. Recurrence of NETs was reported in 2 patients: 1 at 3 months (R0 resection) and the second at 22 months (R1 resection) of follow-up. Conclusion: Our analysis shows that EP is effective in the resection of ampullary NETs with no intraductal extension of the tumor. EP has an acceptable safety profile. However, careful patient selection, multidisciplinary evaluation, and adequate workup are needed before performing EP for ampullary NETs.