1. Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?

A 58-year-old man undergoes EGD for evaluation of long standing GERD. Apart from endoscopic suspicion for Barrett’s esophagus an incidental finding of a 2cm ampullary lesion is noted. Biopsy of the lesion showed revealed an adenoma without any dysplasia. All the following are true of the condition except A. All ampullary lesions above 1cms likely need resection. B. Biopsy of the ampullary lesion fully rules out high grade dysplasia. C. Endoscopic snare ampullectomy is the treatment of choice if lesion is localized. D. Pancreatic stent placement after endoscopic ampullectomy is considered standard of care. E. Recurrence after endoscopic ampullectomy is relatively high (up to 20-25%)