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.