Table 2

Calculation of the modified Spigelman score incorporating the presence of an ampullary adenoma and subsequent screening recommendations

No of points123
No of polyps1–45–20>20
Polyp size (mm)1–45–10>10
HistologyTubulousTubulovillousVillous
DysplasiaMildModerateSevere
PointsStageSurveillance endoscopy
005 years
1–4I5 years
5–6II3 years
7–8III1 year (±endoscopic therapy BSG only)
9–12IV6 months (ESGE)—6–12 months (BSG)±endoscopy or surgery
AmpullaAssessmentMinimum interval adjustment if longer with Spigelman score
NormalNormal5 years
Minor<1 cm, tubular, LGD3 years
Major>1 cm, villious or HGD1 year or consideration of ampullectomy
  • Initial biopsy histology can be used for histology score, with adjustment for earlier surveillance interval if minor or major ampullary adenoma detected (see also figure 2)37 38 40

  • BSG, British Society of Gastroenterology; ESGE, European Society of Gastrointestinal Endoscopy; HGD, high-grade dysplasia; LGD, low grade dysplasia.