1: ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2: ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3: ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4: ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5: ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6: ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7: ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8: ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

Aziende Socio Sanitaria Territoriale Rhodense Gastroenterology Garbagnate Milanese Italy

Department of Digestive Endoscopy Centre Hospitalier Universitaire de Nice Nice France

Department of Endoscopic Services Western Health Melbourne Australia

Department of Gastroenterology and Hepatology Leiden University Medical Center The Netherlands

Department of Gastroenterology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gastroenterology Evangelisches Krankenhaus Düsseldorf Dusseldorf Nordrhein Westfalen Germany

Department of Gastroenterology Freeman Hospital Newcastle upon Tyne UK

Department of Gastroenterology Georges Pompidou European Hospital AP HP Centre Université de Paris Paris France

Department of Gastroenterology Hôpital Nord Assistance publique des hôpitaux de Marseille Marseille France

Department of Medicine Western Health Melbourne Medical School University of Melbourne Victoria Australia

Department of Surgery Cancer Center Amsterdam Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

Department of Surgery Centre for Digestive Diseases Karolinska University Hospital Stockholm Sweden

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Digestive Endoscopy Unit Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Gastroenterology and Hepatology Department Cliniques universitaires Saint Luc Université Catholique de Louvain Brussels Belgium

Gastroenterology Center Klinik Hirslanden Zurich Switzerland

Gastroenterology Hepatopancreatology and Digestive Oncology Erasme Hospital Université Libre de Bruxelles Brussels Belgium

Service de Gastroentérologie Hôpital Privé Jean Mermoz Ramsay Générale de Santé Lyon France

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