Sahyadri Narayana Hospital Performs Malnad’s First Endoscopic Ampullectomy

Shivamogga, April 5, 2025: In a groundbreaking achievement, Sahyadri Narayana Hospital has successfully performed the first-ever Endoscopic Ampullectomy in the Malnad region, offering a new ray of hope to patients with precancerous conditions of the digestive system. This feat was accomplished by the hospital’s skilled team of gastroenterologists, who treated a 72-year-old hypertensive woman suffering from a complex ampullary adenoma with high-grade dysplasia.

Speaking at a press conference, Dr. Shivakumar V, Senior Consultant in Medical Gastroenterology, shared details of this extraordinary case.

“The patient was referred to us with deranged liver function tests (LFTs) and pancreatitis. Upon conducting a Duodenoscopy, we detected an ampullary mass. A follow-up Endoscopic Ultrasound (EUS) revealed a prolapsing mass extending from the common bile duct (CBD) into the second part of the duodenum (D2), with an artery traversing through it. A biopsy confirmed the presence of an ampullary adenoma with high-grade dysplasia, a precancerous lesion requiring immediate attention,” explained Dr. Shivakumar.

Given her advanced age and the risk factors involved with open surgery, the medical team opted for an Endoscopic Ampullectomy—a minimally invasive procedure. The surgery was a resounding success, and the patient was discharged within just 48 hours, completely stable and on the path to recovery.

This clinical breakthrough was made possible due to the exceptional teamwork of Dr. Shivakumar V, Dr. Sumesh Nair S (Assistant Consultant, Medical Gastroenterology), Dr. Satish M R (Senior Consultant, Interventional Radiology), Dr. Chakravarthy Sandur (Medical Superintendent), with the support of hospital administration team, including Managing Director Mr. Varghese P John, Marketing Head (Karnataka) Mr. Rajasingh S V. and Marketing Manager Mr Shylesh SN.

Mr. Varghese P John said, “This achievement reflects Sahyadri Narayana Hospital’s commitment to bringing world-class medical care to the Malnad region. The success of this advanced endoscopic procedure reinforces our mission of providing cutting-edge treatment with a patient-centric approach.”

Ampullary Adenomas and Their Risks

 Ampullary adenomas, though rare, have the potential to transform into ampullary carcinomas if left untreated. Patients typically present symptoms such as jaundice (50-75%), along with less common signs like pruritus (itching), cholangitis (bile duct infection), biliary colic, nausea, vomiting, iron-deficiency anaemia and gastrointestinal (GI) bleeding.

 Diagnosis and Treatment

Diagnosing such conditions requires advanced imaging techniques such as Contrast-Enhanced CT (CECT), Magnetic Resonance Cholangiopancreatography (MRCP), and Endoscopic Retrograde Cholangiopancreatography (ERCP).

 “ERCP remains the gold standard for diagnosing ampullary adenomas, with biopsy and duodenoscopy confirming malignancy risks,” said Dr. Shivakumar. “In cases where imaging and endoscopic evaluation rule out cancer, Endoscopic Ampullectomy is the preferred approach due to its significantly lower morbidity (10%) and mortality (<2%).”

 Endoscopic vs. Surgical Approaches

While surgical interventions such as Total Pancreaticoduodenectomy (known as Whipple procedure) or Surgical Ampullectomy remain options, they are associated with higher risks, including post-operative morbidity (25-60%), mortality (up to 10%), complications like gastric outlet obstruction (42%), common bile duct (CBD) stricture, and pancreatitis.

 By contrast, Endoscopic Ampullectomy offers a safer and minimally invasive alternative, with significantly lower complication rates.

 Both endoscopic and surgical ampullectomies require a two-year follow-up period to monitor for potential recurrences or residual adenomatous tissue. Patients must undergo regular endoscopic surveillance to ensure complete recovery and prevent malignancy.