A survey of ampullectomy practices.

AIM

To investigate the endoscopic ampullectomy practices of expert biliary endoscopists.

METHODS

An anonymous survey was mailed to 79 expert biliary endoscopists to assess ampullectomy practices.

RESULTS

Forty six (58%) biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years (+/- 8.6). Endoscopists performed an average of 1.1 (+/- 0.8) ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was "always" utilized by 67% of respondents vs "sometimes" in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% "always" and 37% "sometimes" performed it prior to resection. Fifty three percent reported "never" performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy (OR = 10.9; P = 0.09). Participants overwhelmingly favored "always" placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection (23%). Argon plasma coagulation was the favored adjunct modality (83%) for removal of residual adenomatous tissue. Practitioners uniformly (100%) preferred follow-up examination to be within 6 mo post-ampullectomy.

CONCLUSION

Among biliary experts, there is less variation in ampullectomy practices than is reflected in the literature.