Are Small Rectal Neuroendocrine Tumors Uniformly Low Risk?

Background/Aims : Ampullary adenomas are precancerous lesions requiring accurate diagnosis and timely intervention to prevent malignant transformation. Endoscopic papillectomy (EP) has emerged as a less invasive alternative to surgery; however, technical variations in practice remain. This study evaluated contemporary real-world approaches to the diagnosis, treatment, and surveillance of ampullary adenomas among pancreatobiliary endoscopists. Methods : A nationwide cross-sectional survey was conducted among pancreatobiliary endoscopists certified by the Korean Pancreatobiliary Association between January 19 and March 2, 2025. A 29-item questionnaire assessed diagnostic methods, procedural techniques, and follow-up strategies. Of 231 invitations sent, 85 responses (36.8%) were analyzed. Respondents were stratified by EP experience: ≤10 years (n=40) and >10 years (n=45). Results : Diagnostic and procedural strategies were largely comparable across the two experience groups. No significant differences were observed in the histologic reassessment, endoscopic ultrasound test, or cross-sectional images. Single pigtail plastic stents were the most preferred type for prophylactic pancreatic stenting, with a significantly higher preference among endoscopists with ≤10 years of experience compared to those with >10 years (92.5% vs 66.7%, p=0.008). For post-procedural bleeding management, fully covered self-expandable metal stents were more frequently used by endoscopists with ≤10 years of experience (47.5% vs 11.1%, p=0.001). Surveillance intervals, follow-up modalities, and timing of stent removal showed substantial heterogeneity, with no standardized patterns. Conclusions : Although general clinical practices appear standardized, significant variability remains in specific procedural and post-procedural approaches. These findings highlight the need for refined guidelines to support a more consistent and comprehensive approach to EP.