“Periampullary adenomas (PA), including both ampullary adenomas (AAs) and duodenal adenomas (DAs), are benign or premalignant mucosal lesions that are either hereditary, most associated with familial adenomatous polyposis (FAP) syndrome, or sporadic, with no known genetic predisposition. In both cases, these uncommon mucosal-based lesions carry malignancy risk and present management dilemmas when not amenable to endoscopic
removal requiring surgical resection. FAP-related PAs are typically large and multifocal and often managed using the Spigelman classification, a point-based system that alerts the clinician of malignancy risk. This classification guides the decision toward continued endoscopic surveillance vs resection vis-à-vis pancreaticoduodenectomy (PD, also known as the “Whipple procedure”). No such scoring system exists for non-FAP-related PAs.”

“Currently, there is no consensus regarding the management or surveillance of non-FAP-related PA given their rarity and unclear natural history. Nonampullary DA may be managed with endoscopic mucosal resection (EMR) in the majority of cases. Studies examining
EMR for nonampullary DA reported complete resection 400 Mavani et al Malignancy Risk in Periampullary Adenoma J Am Coll Surg in 92% to 96% of cases, with recurrence rates ranging from 9% to 22%. The main limitations of EMR are the risk of perforation with large lesions, difficulty navigating periampullary lesions or lesions with explicit ampullary involvement, and discordance between preoperative endoscopic biopsy and histopathology of the surgical specimen. In our study, 59 patients (46.4%) were diagnosed with invasive adenocarcinoma on final surgical pathology. Of 49 patients with high-grade dysplasia on
biopsy, 36 (73.5%) harbored malignancy. These rates of discordance are in line with other studies, which range from 40% to 75%.”

Mavani, Parit T et al. “Multi-Institutional Analysis of Pancreaticoduodenectomy for Nonfamilial Periampullary Adenoma: A Novel Risk Score to Guide Shared Decision-Making.” Journal of the American College of Surgeons vol. 240,4 (2025): 392-402. Full Text for Emory Users