This expert review provides crucial best practice guidance for managing ampullary adenomas, emphasizing improved endoscopic assessment and resection strategies to optimize patient outcomes.

• Ampullary adenomas can harbor malignancy in 20%-40% of cases; obtaining at least six biopsies is essential for accurate histopathological assessment.
• Use side-viewing duodenoscopes for better visualization and reduced pancreatitis risk during biopsy; avoid pancreatic orifice during procedures.
• Endoscopic resection is generally appropriate for lesions <4-5 cm with minimal intraductal extension, while significant intraductal extension (>1 cm) warrants surgical referral.

Surgeons should prioritize early detection and careful evaluation of ampullary neoplasms, integrating multidisciplinary discussions for high-risk cases.