The ampulla, or ampulla of vater, is where the pancreatic duct and bile duct join together to drain into the duodenum, which is the first part of the small intestine. A polyp of the ampulla starts out benign but can turn into cancer of the ampulla as it grows. At the Bile Duct and Pancreatic Diseases Program, part of the University of Michigan’s Division of Gastroenterology, our multidisciplinary team provides the newest, minimally invasive treatments for removing ampullary polyps, performed by experienced gastroenterologists with high volumes in these procedures.
If left untreated, ampullary polyps can cause a blockage to the pancreatic duct and/or bile duct. Bile duct blockage, bacterial infection, and pancreatitis can occur. More importantly, ampullary polyps lead to ampullary cancer, which is treated in our Multidisciplinary Pancreas Clinic.
Symptoms for Ampullary Polyps
Usually, there are no symptoms for ampullary polyps until they are blocking the exit of bile or pancreatic juices, which can cause attacks of pancreatitis (inflammation of the pancreas) or elevated liver enzymes. Then symptoms can include:
- Severe abdominal pain
- Nausea
- Vomiting
- Fever
- Jaundice
Diagnosing Polyps of the Ampulla
To diagnose ampullary polyps, we begin with a comprehensive exam and collecting a thorough history. An upper endoscopy with biopsy is generally required.
Upper endoscopy, also known as an esophagogastroduodenoscopy or EGD, uses an endoscope—a lighted, flexible tube, about the thickness of a finger—to examine the upper gastrointestinal tract, consisting of the esophagus, stomach, and duodenum, which is the first part of the small intestine. A special instrument is passed through the tube to take a small piece of tissue (a biopsy) for examination in the laboratory.
Treating an Ampullary Polyp
If there is no evidence of ampullary cancer and the polyp is not too large, the treatment is a procedure called endoscopic retrograde cholangiopancreatography (ERCP)with placement of a temporary pancreatic duct stent (which looks like a plastic straw).
An ERCP is a minimally invasive procedure that combines x-ray and upper endoscopy. The doctor passes the tube through the mouth and into the stomach, then injects a contrast dye into the ducts to view the pancreatic and bile ducts, which can be seen on x-ray. Special tools can be guided through the endoscope to remove the polyp, and then a duct stent is inserted to keep the pancreatic duct open during healing. Since the opening to the pancreatic duct is very tiny, only 1-2 millimeters, any swelling from the procedure could close off the opening to the pancreatic duct, which would cause pancreatitis. The duct stent keeps the duct open as it heals.
Patients who have had endoscopic retrograde cholangiopancreatography can typically go home same day, once their sedation wears off.
If the polyp already contains cancer or is too large, it must be removed through traditional surgery.
Ampullary Polyp Research at the University of Michigan
Our dedicated researchers recently led a multi-center clinical trial showing the benefit of a medication called indomethacin, which is given after endoscopic retrograde cholangiopancreatography to lower complications of high-risk procedures like ampullectomy. As one of the largest digestive and liver health programs in the country we frequently participate in clinical trials and are thus able to refer our patients for gastrointestinal trials that apply to their particular condition.
Other Information About Digestive and Liver Health
To see related medical services we offer, visit our Digestive and Liver Health overview page.
Make an Appointment
To schedule an appointment to discuss ampullary polyps or any other gastrointestinal problem, call the GI Call Center at 888-229-7408. If you have questions about cancer, call the University of Michigan Cancer Answer Line at 800-865-1125.