Ampullary lesions are rare, with an annual incidence of approximately 1:100,000. However, there is evidence that their incidence is increasing in patients aged >50 years. Although predominantly benign, many lesions transform into malignancy and can also cause cholangitis and pancreatitis. Timely resection is therefore warranted in selected cases. This study aimed to assess the safety, efficacy, and clinical outcomes of outpatient endoscopic resection (ER) of ampullary lesions performed at a single tertiary center.

Between 2021 and 2024, 13 patients (11 men, 2 women; age range 62-88 years, median age 70.8 years) underwent a total of 14 ER procedures for ampullary lesions. All patients underwent baseline assessment with upper endoscopy, computed tomography, magnetic resonance imaging, and endoscopic ultrasound. The most common clinical features were abdominal pain and obstructive jaundice. Imaging studies were performed every 6 months after ER.

Follow-up ranged from 6 to 48 months (median 28 months). En bloc ER was achieved in 92% of procedures. Only one case of recurrence was observed at 6 months and successfully managed endoscopically. Two patients required surgical resection after ER because biopsy specimens showed invasive adenocarcinoma. Five patients received a 5-Fr pancreatic stent, and 10 patients received rectal nonsteroidal anti-inflammatory drugs after the procedure. Figure 1 shows a case of ampullary adenoma with vegetative appearance. Figure 2 shows an ampullary adenoma covered with normal mucosa. One patient was admitted to the emergency department 48 hours after ER with gastrointestinal bleeding and hemodynamic repercussion, where she received medical care and blood transfusion. Upper endoscopy showed a visible vessel at the margin of the ulcer, which was successfully treated endoscopically. She was discharged 48 hours later.

Outpatient ER of ampullary lesions is a safe therapeutic modality, with low complication and recurrence rates. Careful preoperative evaluation with endoscopic ultrasound is essential to assess local invasion and avoid ER in cases suspicious for malignancy.