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Stornello C, Cristofori C, Checchin D, de Palo MG, Grillo S, Peserico G, Quintini D, Gruppo M, De Simoni O, Fantin A. The Role of Endoscopic Ultrasound in Ampullary Lesion Management. Diagnostics (Basel) 2024; 14:1855. [PMID: 39272640 PMCID: PMC11394035 DOI: 10.3390/diagnostics14171855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/07/2024] [Accepted: 08/21/2024] [Indexed: 09/15/2024] Open
Abstract
Ampullary lesions, neoplasms originating in the papilla of Vater, represent a rare yet clinically significant group of tumors with diverse etiologies and management challenges. This comprehensive review aims to elucidate the pivotal role of endoscopic ultrasound (EUS) in the diagnosis, staging, and management of ampullary lesions. This review begins by providing an overview of ampullary lesions, their epidemiology, and associated risk factors. We delve into their clinical presentation, emphasizing the importance of early and accurate diagnosis. Furthermore, we explore the limitations of traditional diagnostic modalities and highlight the growing relevance of EUS in ampullary lesion evaluation. We discuss the superior spatial resolution of EUS in comparison with other imaging methods, and we present an in-depth analysis of EUS-guided sampling and its pivotal role in obtaining histological samples for accurate diagnosis. In addition to diagnosis, we examine the indispensable role of EUS in ampullary lesion staging and its clinical implications. Furthermore, we discuss the potential of EUS in the surveillance and follow-up of ampullary lesions, ensuring timely detection of recurrence and monitoring treatment response in sporadic cases and in the context of familial syndromes, such as familial adenomatous polyposis (FAP). In conclusion, this review underscores the indispensable role of endoscopic ultrasound in the multifaceted approach to ampullary lesion evaluation. EUS not only enhances diagnostic accuracy but also informs treatment decisions and minimally invasive therapeutic interventions. As our understanding of ampullary lesions continues to evolve, EUS remains an invaluable tool for the improvement of patient outcomes and quality of life.
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Affiliation(s)
- Caterina Stornello
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Chiara Cristofori
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Davide Checchin
- Gastroenterology Unit, Dell'Angelo Hospital, 30174 Venice, Italy
| | - Maria Grazia de Palo
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Sabina Grillo
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Giulia Peserico
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Dario Quintini
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Mario Gruppo
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Ottavia De Simoni
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
| | - Alberto Fantin
- Gastroenterology Unit, Veneto Institute of Oncology IOV-IRCCS, 35100 Padua, Italy
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Wang Y, Khizar H, Zhou H, Jin H, Lou Q, Zhang X, Yang J. Endoscopic treatment for early duodenal papillary carcinoma: long-term outcomes. J Gastroenterol Hepatol 2024; 39:1367-1373. [PMID: 38528742 DOI: 10.1111/jgh.16546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/24/2024] [Accepted: 03/03/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND AIM This study aims to determine whether endoscopic papillectomy (EP) is a safe and effective treatment for early duodenal papillary carcinoma with long-term follow-up. METHODS From June 2012 to September 2022, 48 patients with early duodenal papilloma carcinoma who received endoscopic treatment were included. The histological types, percentage of complete resections, postoperative residuals, adverse events, and recurrences were evaluated. RESULTS EP was successful in all patients; 46 were lumped, and two were fragmented, with a 95.8% intact removal rate (46/48). The preoperative biopsy pathological positive rate was 70.8% (34/48). The incidence of early postoperative adverse events (within 1 month after EP) were 16.7% (8/48), including four cases of acute pancreatitis, three cases of delayed bleeding, and one case of acute cholangitis. In addition, 4.2% (2/48) of the late adverse events were bile duct stenosis. After 6 months, the postoperative residual rate was 0%. The median time to recurrence was 17.5 months, and the postoperative recurrence rate was 16.7% (8/48) in patients treated with radiofrequency ablation. The median progression-free survival was 18.6 months (95% CI, 12.1-25.1), and the median overall survival was 121.5 months (95% CI, 105.6-120.9). CONCLUSIONS EP is a safe and efficient alternative therapy for early duodenal papillary carcinoma. Endoscopic follow-up and treatment are essential because of the potential for recurrence.
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Affiliation(s)
- Yingyu Wang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
- Department of Gastroenterology, Yuhang First People's Hospital, Hangzhou, Zhejiang, China
| | - Hayat Khizar
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
- Department of Oncology, The Fourth Affiliated Hospital, International Institute of Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Haibin Zhou
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Hangbin Jin
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Qifeng Lou
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
| | - Jianfeng Yang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, Zhejiang, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, Zhejiang, China
- Hangzhou Institute of Digestive Diseases, Hangzhou, Zhejiang, China
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Maselli R, de Sire R, Fugazza A, Spadaccini M, Colombo M, Capogreco A, Beyna T, Repici A. Updates on the Management of Ampullary Neoplastic Lesions. Diagnostics (Basel) 2023; 13:3138. [PMID: 37835881 PMCID: PMC10572979 DOI: 10.3390/diagnostics13193138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Ampullary neoplastic lesions (ANLs) represent a rare cancer, accounting for about 0.6-0.8% of all gastrointestinal malignancies, and about 6-17% of periampullary tumors. They can be sporadic or occur in the setting of a hereditary predisposition syndrome, mainly familial adenomatous polyposis (FAP). Usually, noninvasive ANLs are asymptomatic and detected accidentally during esophagogastroduodenoscopy (EGD). When symptomatic, ANLs can manifest differently with jaundice, pain, pancreatitis, cholangitis, and melaena. Endoscopy with a side-viewing duodenoscopy, endoscopic ultrasound (EUS), and magnetic resonance cholangiopancreatography (MRCP) play a crucial role in the ANL evaluation, providing an accurate assessment of the size, location, and characteristics of the lesions, including the staging of the depth of tumor invasion into the surrounding tissues and the involvement of local lymph nodes. Endoscopic papillectomy (EP) has been recognized as an effective treatment for ANLs in selected patients, providing an alternative to traditional surgical methods. Originally, EP was recommended for benign lesions and patients unfit for surgery. However, advancements in endoscopic techniques have broadened its indications to comprise early ampullary carcinoma, giant laterally spreading lesions, and ANLs with intraductal extension. In this paper, we review the existing evidence on endoscopic diagnosis and treatment of ampullary neoplastic lesions.
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Affiliation(s)
- Roberta Maselli
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Roberto de Sire
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy
| | - Alessandro Fugazza
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
| | - Marco Spadaccini
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Matteo Colombo
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
| | - Antonio Capogreco
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
| | - Torsten Beyna
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus, 40217 Düsseldorf, Germany;
| | - Alessandro Repici
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (A.F.); (M.S.); (M.C.); (A.C.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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Vanbiervliet G, Strijker M, Arvanitakis M, Aelvoet A, Arnelo U, Beyna T, Busch O, Deprez PH, Kunovsky L, Larghi A, Manes G, Moss A, Napoleon B, Nayar M, Pérez-Cuadrado-Robles E, Seewald S, Barthet M, van Hooft JE. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:429-448. [PMID: 33728632 DOI: 10.1055/a-1397-3198] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
1: ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2: ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3: ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4: ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5: ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6: ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7: ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8: ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.
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Affiliation(s)
- Geoffroy Vanbiervliet
- Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Marin Strijker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Arthur Aelvoet
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Urban Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Beyna
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Olivier Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre H Deprez
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Manes
- Aziende Socio Sanitaria Territoriale Rhodense, Gastroenterology, Garbagnate Milanese, Italy
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Bertrand Napoleon
- Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Stefan Seewald
- Gastroenterology Center, Klinik Hirslanden, Zurich, Switzerland
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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Lee HS, Jang JS, Lee S, Yeon MH, Kim KB, Park JG, Lee JY, Kim MJ, Han JH, Sung R, Park SM. Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors. Clin Endosc 2015; 48:239-46. [PMID: 26064825 PMCID: PMC4461669 DOI: 10.5946/ce.2015.48.3.239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 12/30/2022] Open
Abstract
Background/Aims Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. Methods We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. Results Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken. Conclusions Endoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required.
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Affiliation(s)
- Hee Seung Lee
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jong Soon Jang
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seungho Lee
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Myeong Ho Yeon
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae Geun Park
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joo Young Lee
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Jin Kim
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Rohyun Sung
- Department of Pathology, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seon Mee Park
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
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Soni RC, Puri AS, Garg V, Sachdeva S, Banka A, Tyagi P, Saran RK. Comparative yield of fine needle aspiration cytology, ampullary biopsy, and needle knife assisted biopsy in the diagnosis of nonulcerated periampullary tumors. Indian J Gastroenterol 2013; 32:258-61. [PMID: 23700137 DOI: 10.1007/s12664-013-0333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 04/12/2013] [Indexed: 02/04/2023]
Abstract
AIM Periampullary tumors (PAT) are defined as tumors arising within 2 cm of the major duodenal papilla. Studies on yield of preoperative biopsy for nonulcerated PAT are scarce. Needle knife papillotomy-assisted biopsy (NKAB) may sample the deeper tissues and thereby increase the histologic yield. We aimed to compare the diagnostic yield of fine needle aspiration cytology (FNAC), surface ampullary biopsy, and NKAB in nonulcerated PAT. METHODS Patients with suspected PAT based on clinical, biochemical, and radiologic investigations were evaluated. Patients with smooth ampullary bulge on side viewing endoscopy (SVE) were included, while those with gastric outlet obstruction or obvious ulceration of ampulla on SVE were excluded. RESULTS Twenty-five of 78 patients with PAT met the inclusion criteria. The median (range) age was 60 (43-75) years, and 13 were male. Serum CA 19.9 was 466 (2-9372) U/mL. Histopathological positivity rate for surface biopsy, FNAC, and NKAB was 10 (40 % and 95 % CI: 21.8 % to 61.1 %), 12 (48 % and 95 % CI: 28.3 % to 68.2 %), and 21 (84 % and 95 % CI: 63.1 % to 94.7 %), respectively. Diagnostic yield of NKAB was significantly better than surface biopsy (p = 0.001) and FNAC (p = 0.007). None of the patients subjected to NKAB had any complications other than self-limited minor ooze. CONCLUSION NKAB was superior to surface biopsy or FNAC to establish preoperative tissue diagnosis of nonulcerated PAT. NKAB is safe and simple in expert hands and may be recommended as standard procedure to obtain histological specimen in these patients.
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Affiliation(s)
- Ram Chandra Soni
- Department of Gastroenterology, G B Pant Hospital, J L Nehru Marg, New Delhi 110 002, India
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Noor MT, Vaiphei K, Nagi B, Singh K, Kochhar R. Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma. World J Gastrointest Endosc 2011; 3:220-4. [PMID: 22110838 PMCID: PMC3221954 DOI: 10.4253/wjge.v3.i11.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 09/23/2011] [Accepted: 10/18/2011] [Indexed: 02/05/2023] Open
Abstract
AIM: To study the role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma.
METHODS: In this study the authors retrospectively analyzed clinical records of patients with periampullary tumors diagnosed by ampullary biopsy taken after needle knife papillotomy in whom surface ampullary biopsies were non contributory.
RESULTS: Between January 2008 and December 2010, 38 patients with periampullary tumors were seen by us and initial side viewing endoscopy with surface biopsy from the papilla was positive for malignancy in 25 patients. Thirteen patients with a negative surface biopsy for malignancy underwent a repeat ampullary biopsy following needle knife papillotomy. There were 8 (61.5%) males and 5 (38.5%) females. The most common presenting symptom was jaundice (100%), followed by fever (46.2%), melena (38.5%), abdominal pain (30.8%) and weight loss (30.8%). All the patients had hyperbilirubinemia with a mean ± SD serum bilirubin of (11.2 ± 1.9) mg/dL (normal value < 1 mg%) and the mean ± SD serum alkaline phosphatase was (288.0 ± 94.3) IU/L (normal value < 129 IU/L). Serum CA 19.9 level estimation was done in 11 patients; it was elevated (cut off value > 70.5 IU/L) in all of them with a median of 1200 IU/L (inter quartile range 274-3500). Side viewing endoscopy showed a bulky papilla in all of them. Adequate tissue was obtained in all of the 13 patients for histological evaluation; 12 of the 13 patients were reported to have adenocarcinoma while one patient had adenoma. There were no complications from the needle knife papillotomy in any of the patients.
CONCLUSION: Needle knife assisted ampullary biopsy appears to be a safe and effective diagnostic modality for periampullary carcinoma.
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Affiliation(s)
- Mohd Talha Noor
- Mohd Talha Noor, Kim Vaiphei, Birinder Nagi, Kartar Singh, Rakesh Kochhar, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Khan F, Vessal S. The disappearing abdominal mass: a duodenal pseudotumour. BMJ Case Rep 2011; 2011:bcr.01.2011.3746. [PMID: 22689546 DOI: 10.1136/bcr.01.2011.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Reports of inflammatory pseudotumours can be found in the literature affecting different organs of the body. The authors present a case and discuss the differential diagnosis of an inflammatory duodenal mass. Both symptomatology and radiological findings suggested a more sinister cause, such as a malignancy. However, histological analysis revealed normal mucosa and after conservative management the mass spontaneously resolved.
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Affiliation(s)
- Faraan Khan
- Department of General Medicine, Barnet Hospital, London, UK.
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Lymphoplasmacytic granuloma localized to the ampulla of Vater: an ampullary lesion of IgG4-related systemic disease? Gastrointest Endosc 2008; 68:1229-32. [PMID: 18547570 DOI: 10.1016/j.gie.2008.02.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 02/23/2008] [Indexed: 02/08/2023]
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Plard L, Leone S, Rod J, Chiche L. [Adenomyoma of the main biliary tract: a real diagnostic trap. Two cases and a review of the literature]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2007; 31:1005-1009. [PMID: 18166896 DOI: 10.1016/s0399-8320(07)78321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Adenomyoma of the biliary tract is a benign neoplasm but its clinical, radiological and intraoperative features can mimic pancreatic or biliary cancer. These similarities may yield to useless pancreatoduodenectomy. We report here two cases of adenomyoma treated by pancreatoduodenectomy. The analysis of these two cases and the review of literature show that radiological and pathological knowledge of this disease, associated with pre and intraoperative evaluation (echoendoscopy-guided biopsy, brushing and intraoperative biopsy) can achieve diagnosis and thus may avoid inappropriate resection. For asymptomatic patient, simple follow-up seems to be the rule. For symptomatic patient endoscopic resection or surgical segmentary resection where appropriate is recommended.
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Affiliation(s)
- Laurent Plard
- Service de chirurgie hépatobiliaire et transplantation hépatique, CHU Caen, Caen
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Adsay NV, Basturk O, Klimstra DS, Klöppel G. Pancreatic pseudotumors: non-neoplastic solid lesions of the pancreas that clinically mimic pancreas cancer. Semin Diagn Pathol 2005; 21:260-7. [PMID: 16273945 DOI: 10.1053/j.semdp.2005.07.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the pancreas, a variety of non-neoplastic conditions may form solid masses that may mimic cancer. Up to 5% of pancreatectomies performed with the preoperative clinical diagnosis of carcinoma will prove to be non-neoplastic by pathologic examination, although this figure is decreasing with improved diagnostic modalities. Chronic inflammatory lesions are the leading cause of this phenomenon ("pseudotumoral pancreatitis"), and among these, autoimmune and paraduodenal pancreatitides (discussed separately in this issue) are most important. In this article, we will focus on the noninflammatory lesions that may form tumor-like lesions of the pancreas. Adenomyomatous hyperplasia of ampulla of Vater is a subtle lesion that is difficult to define; larger examples (>5 mm) have been found to be the cause of obstructive jaundice. Accessory (heterotopic) spleen may form a well-defined nodule within the tail of the pancreas and is typically mistaken for endocrine neoplasm. Lipomatous hypertrophy is the replacement of pancreatic tissue with mature adipose tissue that occasionally leads to moderate to marked enlargement of the pancreas. Hamartomas are very rare if the entity is defined strictly. They are characterized by irregularly arranged mature pancreatic elements admixed with stromal tissue. A cellular, spindle-cell variant with c-kit (CD117) expression is recognized. Pseudolymphoma forms well-defined nodules composed of hyperplastic lymphoid tissue. Rarely, foreign-body deposits, granulomatous inflammations (such as sarcoidosis or tuberculosis), and congenital lesions may form tumoral lesions. In conclusion, it is important to recognize the types of conditions that form pseudotumors in the pancreas so that they can be distinguished from ductal adenocarcinomas, especially clinically, but also pathologically. Nonspecific terms such as "inflammatory pseudotumor" ought to be avoided, and every attempt should be made to classify a "pseudotumor" into a more specific diagnostic category discussed above.
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Affiliation(s)
- N Volkan Adsay
- Karmanos Cancer Institute/Wayne State University, Detroit, Michigan, USA.
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Unno H, Saegusa H, Fukushima M, Hamano H. Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis. Gastrointest Endosc 2002. [PMID: 12447302 DOI: 10.1016/s0016-5107(02)70364-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND There are no descriptions of the appearance of the main duodenal papilla in sclerosing pancreatitis. The intent of the present study was to clarify the characteristics of the main duodenal papilla in patients with sclerosing pancreatitis. METHODS Macroscopic findings at ERCP with reference to the main duodenal papilla of 17 patients with sclerosing pancreatitis were compared with those of 24 patients with normal ERCP findings, 11 with chronic pancreatitis, 13 with primary sclerosing cholangitis, 21 with pancreatic cancer, and 18 with bile duct cancer. Endoscopic photographs of the papilla were reviewed retrospectively by 3 observers blinded to the underlying pancreaticobiliary pathology. Degree of swelling was scored in all patients. Biopsy specimens from swollen papillae were assessed histopathologically in 3 patients with sclerosing pancreatitis. RESULTS Severe swelling of the main duodenal papilla was observed in 7 (41%) of 17 patients with sclerosing pancreatitis. The total score for the degree of swelling in patients with sclerosing pancreatitis was significantly higher than that for patients with a normal ERCP, chronic pancreatitis, primary sclerosing cholangitis, pancreatic cancer, and bile duct cancer (p < 0.01). T-lymphocyte infiltration of the papilla was evident in the biopsies from 3 patients with sclerosing pancreatitis. CONCLUSIONS A swollen main duodenal papilla was a characteristic finding in patients with sclerosing pancreatitis. T-lymphocyte infiltration is present in the swollen main duodenal papilla. These features may be useful in the diagnosis of sclerosing pancreatitis.
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Affiliation(s)
- Hiroshi Unno
- The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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14
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Affiliation(s)
- M H Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Nikfarjam M, Muralidharan V, McLean C, Christophi C. Local resection of ampullary adenocarcinomas of the duodenum. ANZ J Surg 2001; 71:529-33. [PMID: 11527262 DOI: 10.1046/j.1440-1622.2001.02185.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is considered to be the optimal treatment for ampullary adenocarcinomas. Local resection (LR) is a less invasive and potentially equally effective alternative for cancers with favourable prognostic features. Identification of these prognostic parameters may allow selection of patients suitable for LR. METHODS Twenty-five patients were treated for a primary Vater's ampulla adenocarcinoma at the Alfred Hospital, Melbourne, Australia, between January 1989 and January 2000. Risk factors for cancer recurrence were evaluated and the specific role of LR was defined. RESULTS Fourteen patients had PD, five had LR and six had bypass procedures (five biliary stents; one operative bypass). Presenting symptoms included jaundice (64%), abdominal pain (54%) and weight loss (32%). Adenocarcinomas that were resected had a median diameter of 2.5 cm, and were limited to the ampulla in 26% (T1), invaded the duodenal wall in 42% (T2) and infiltrated 2 cm or less into the pancreas in 32% (T1) of cases. Locally resected cancers were confined to the ampulla or invaded the duodenum and recurred in one patient following excision. Six recurrences occurred in total, influenced significantly by T staging (P = 0.009). Patient age, preoperative symptoms, laboratory tests, tumour size, differentiation, ulceration, lymphovascular spread and perineural invasion had no effect on recurrence. Patients undergoing LR had lower morbidity and mortality, reduced blood transfusion requirements and shorter hospital stay than those treated by PD. CONCLUSIONS T staging predicts the risk of tumour recurrence and can be determined using endoscopic ultrasound. Local resection is a suitable alternative to pancreaticoduodenal resection in patients with T1 and T2 adenocarcinomas with a maximum diameter of 3 cm or less.
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Affiliation(s)
- M Nikfarjam
- Department of Surgery, Alfred Hospital Melbourne, Victoria, Australia.
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16
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Roberts RH, Krige JEJ, Bornman PC, Terblanche J. Pancreaticoduodenectomy for Ampullary Carcinoma. Am Surg 1999. [DOI: 10.1177/000313489906501110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thirty-two consecutive patients with adenocarcinoma of the ampulla of Vater who had curative resection by pancreaticoduodenectomy were analyzed to determine the accuracy of preoperative investigations and factors that influenced survival. Obstructive jaundice was present in 31 patients, and most patients had pain and weight loss. Ultrasound was more useful than CT in identifying biliary obstruction, whereas CT was more accurate in demonstrating pancreatic duct dilatation and an ampullary mass. Endoscopic retrograde cholangiopancreatography with biopsy and brush cytology was the most accurate investigation and proved or was suspicious of carcinoma in all patients. Nineteen patients had postoperative complications, three of whom died (9.4%)—two of sepsis and one from aspiration following hematemesis. Actuarial 5-year survival was 46 per cent. Stage of disease was the strongest predictor of survival. All patients with T1 lesions are alive more than 5 years after resection. Patients with lymph node metastases had a significantly shorter survival than node-negative patients (P = 0.00087). Pancreaticoduodenectomy is advocated for ampullary carcinoma in good-risk patients, with the anticipation of prolonged survival in those with early (T1) lesions and node-negative disease.
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Affiliation(s)
- R. H. Roberts
- Department of Surgical Gastroenterology, Groote Schuur Hospital and Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - J. E. J. Krige
- Department of Surgical Gastroenterology, Groote Schuur Hospital and Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - P. C. Bornman
- Department of Surgical Gastroenterology, Groote Schuur Hospital and Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - J. Terblanche
- Department of Surgical Gastroenterology, Groote Schuur Hospital and Department of Surgery, University of Cape Town, Cape Town, South Africa
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17
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Menzel J, Poremba C, Dietl KH, Böcker W, Domschke W. Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol 1999; 10:1227-31. [PMID: 10586341 DOI: 10.1023/a:1008368807817] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It has been proposed that adenomas of the papilla of Vater are precursors of adenocarcinomas. Duodenoscopy with ERCP and forceps biopsies have substantially improved the morphologic exploration of the major duodenal papilla. Yet there is little and contradictory information as to the diagnostic accuracy of endoscopic biopsies in tumors of the papilla. Moreover, after endoscopic sphincterotomy data on the diagnostic impact of endoscopic biopsies from the papilla are scarce and, in most cases, retrospectively obtained. Thus, the aim of the present prospective and histopathologically controlled study was to assess the diagnostic accuracy of endoscopic biopsies taken from tumors of the papilla before and after sphincterotomy. PATIENTS AND METHODS Forty patients with tumors of the papilla of Vater were included in the study. In each case, a comparison was made between endoscopic forceps biopsy diagnoses prior to and following sphincterotomy and the definitive histological diagnosis after surgical tumor resection. RESULTS Resected tumors were diagnosed histomorphologically as follows: 19 adenocarcinomas (47%), 6 tubular adenomas (15%), 7 villous adenomas (17%), 7 inflammatory non-neoplastic lesions (pseudotumors) (17%), and one adenomyoma (2%). Overall accuracy for preoperative histopathological diagnosis was 62% (25 of 40, 95% CI: 47%-76%) prior to sphincterotomy while it was 70% (28 of 40, 95% CI: 55%-81%) following the procedure. Regarding adenocarcinomas, sensitivity was found to be 21% (4 of 19, 95% CI: 8%-43%) prior to and 37% (7 of 19, 95% CI: 19%-58%) after sphincterotomy while specificity was 100% at both times. CONCLUSIONS Endoscopic forceps biopsies do not allow for reliable preoperative diagnosis of tumors of the papilla of Vater.
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Affiliation(s)
- J Menzel
- Department of Medicine B, University of Münster, Germany.
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18
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Abstract
Adenomyomas of the bile ducts are extremely rare. They are most likely often overlooked also when situated in the ampulla of Vater and obstructing bile flow. Of 3,131 endoscopic retrograde cholangiograms, four patients with ampullary adenomyoma and signs of biliary obstruction have been diagnosed. When recognized they can be treated effectively by endoscopic means. However, their radiologic and endoscopic appearances were found difficult to interpret and led to unnecessary endoscopic sessions in one patient and surgery in another. Thus, increased awareness of this entity is important to avoid overlooking or misdiagnosing it.
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19
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Lucena JF, Alvarez OA, Gross GW. Endoscopic resection of heterotopic pancreas of the minor duodenal papilla: case report and review of the literature. Gastrointest Endosc 1997; 46:69-72. [PMID: 9260710 DOI: 10.1016/s0016-5107(97)70214-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J F Lucena
- Department of Medicine, University of Texas Health Science Center at San Antonio, 78284-7878, USA
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20
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21
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Abstract
BACKGROUND Our aims were to investigate the question as to whether the adenoma-carcinoma sequence also applies to the papilla of Vater and to determine the frequency with which a tumour of the papilla of Vater, diagnosed histologically as containing portions of an adenoma, already contains adenocarcinoma elsewhere. METHODS A retrospective analysis was carried out of the forceps, snare biopsy, and excised specimens obtained from the papilla of Vater in 559 patients, including 210 patients with the primary diagnosis of carcinoma and 110 patients with the diagnosis of 'portions of an adenoma'. Comparisons were made of the age distribution of patients with adenoma and those with carcinoma, and the frequency of residual adenoma in a carcinoma as a function of degree of malignancy, T stage, and UICC stage. A follow-up examination of the patients with the primary diagnosis 'parts of an adenoma of the papilla of Vater' was performed. RESULTS The average age of the patients with the final diagnosis adenoma was 65.2 years, and that of the carcinoma patients 73.0 years. Residual adenoma was found in 54.9% of the 51 surgical specimens and in 31.7% of the 159 biopsy specimens obtained from carcinomas. The frequency of residual adenoma in carcinomas decreased statistically significantly with increasing T stage and degree of malignancy. The follow-up examination of the 110 patients with the primary biopsy diagnosis parts of an adenoma of the papilla of Vater showed unequivocal results in 80 cases. Only in 39.7% of these cases was the primary diagnosis adenoma confirmed, whereas in 60.25%, further histologic examination showed a carcinoma. CONCLUSIONS An analysis of our results, together with those reported in the literature, indicates that the adenoma-carcinoma sequence also applies to the papilla of Vater and that, in a high percentage of patients with the histologic diagnosis 'parts of an adenoma, other regions of the tumour already contain a carcinoma.
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Affiliation(s)
- M Stolte
- Institute of Pathology, Klinikum Bayreuth, Germany
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22
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Ekbom A, Yuen J, Karlsson BM, McLaughlin JK, Adami HO. Risk of pancreatic and periampullar cancer following cholecystectomy: a population-based cohort study. Dig Dis Sci 1996; 41:387-91. [PMID: 8601387 DOI: 10.1007/bf02093833] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An increased risk of pancreatic cancer following cholecystectomy has been reported in some studies but not in others. In order to settle this question, a population-based cohort consisting of 62,615 patients who had undergone cholecystectomy was followed up for the occurrence of pancreatic and periampullar cancer up to 23 years. After excluding the first year after operation, there were 261 pancreatic cancers vs 216.8 expected [standardized incidence ratio (SIR) = 1.20; 95% confidence interval (CI) = 1.06-1.37]; and 11 periampullar cancers vs 7.2 expected (SIR = 1.52; 95% CI = 0.76-2.72). The increased risk of pancreatic cancer was most prominent up to four years after operation, but was also significantly increased 15 years or more after operation (SIR = 1.35; 95% CI = 1.00-1.78). We conclude that there is a modest excess risk of pancreatic and periampullar cancer following cholecystectomy, most prominent up to four years after operation, but that also exists 15 years or more after operation.
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Affiliation(s)
- A Ekbom
- Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden
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23
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Abstract
The case of a 50-year-old man with abdominal pain and abnormal liver test results is described. Endoscopic retrograde cholangiopancreatography with manometric studies showed biliary dilatation, poor ductal drainage, and sphincter of Oddi dysfunction. Clinical and radiographic clues suggested the possibility of an ampullary lesion; a small ampullary adenoma was detected after endoscopic sphincterotomy, and ampullary carcinoma was found in the operative specimen. Malignancy can cause sphincter dysfunction not only in the esophagus (as pseudoachalasia) but in the ampulla of Vater as well.
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Affiliation(s)
- M Topazian
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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24
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Venu RP, Rolny P, Geenen JE, Hogan WJ, Komorowski RA. Ampullary hamartoma: endoscopic diagnosis and treatment. Gastroenterology 1991; 100:795-798. [PMID: 1993502 DOI: 10.1016/0016-5085(91)80028-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study shows a patient who presented with intermittent biliary tract obstruction caused by ampullary hamartoma. Endoscopic retrograde cholangiopancreatography showed a large ulcerated papilla and dilated biliary ducts. Tissue diagnosis was established by a large particle biopsy obtained with a snare. The patient underwent a successful endoscopic sphincterotomy and has remained symptom free for 4 years.
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Affiliation(s)
- R P Venu
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee
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25
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Chang CP, Ng WW, Tsay SH, Lai KH, Lee SD. Differential diagnosis of tumor-like appearance of the papilla of Vater. Gastrointest Endosc 1990; 36:635-6. [PMID: 2279669 DOI: 10.1016/s0016-5107(90)71196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Abstract
Endoscopic biopsy specimens and surgically resected specimens in a collective series of 78 Japanese patients with ampullary tumor were retrospectively reviewed to investigate the clinical implications of endoscopic biopsy. Endoscopic biopsy specimens were classified into five groups based on the degree of epithelial atypia: group 1 (no atypia), group 2 (mild atypia), group 3 (moderate atypia or adenoma), group 4 (severe atypia or carcinoma in situ), and group 5 (invasive carcinoma). Final diagnosis of the 78 resected ampullary tumors was adenoma in five cases, carcinoma in 27 cases, and both adenoma and carcinoma in 46 cases. Biopsy accuracy of carcinoma (group 4 or 5) was 70% (51 of 73) overall in 73 carcinoma cases. Biopsy accuracy was 50% (7 of 14) in the intramural protruding type, 64% (21 of 33) in the exposed protruding type, and 88% (23 of 26) in the ulcerating type. The diagnostic accuracy of adenoma (group 3) was 80% (4 of 5) in five cases of ampullary adenoma. In 18 (25%) of the 73 carcinoma cases, biopsy diagnosis was adenoma (group 3), whereas carcinoma was found in the deeper layers of surgically resected specimens. Biopsy diagnosis of adenoma does not rule out the possibility of deeper carcinoma in ampullary tumors.
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Affiliation(s)
- K Yamaguchi
- Department of Surgery, Shinkokura Hospital, Kitakyushu, Japan
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27
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Abstract
The role of endoscopy in managing biliary tract stones and stenosis is surveyed. Rapid advances in endoscopic videoimaging with small diameter maneuverable or large instrument channel endoscopes allows diagnosis and therapy under visual or radiographic control at almost any site in the biliary tree. Techniques for cytology, biopsy, sphincterotomy, mechanical or laser lithotripsy, dilatation with balloon or bougie, large (15 F) or small stent insertion, "polypectomy" or excision with laser or electrosurgery, and brachytherapy provide a therapeutic armamentarium that must be considered as painless, low risk, and cost-effective alternatives to surgical or percutaneous therapy.
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Affiliation(s)
- D S Zimmon
- Department of Medicine, Radiology, and Surgery, St. Vincent's Hospital, New York, New York
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28
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Qizilbash AH. Duodenal and peri-ampullary adenomas. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1990; 81:77-90. [PMID: 2407447 DOI: 10.1007/978-3-642-74662-8_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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29
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Lowes JR, Rode J, Lees WR, Russell RC, Cotton PB. Obstructive pancreatitis: unusual causes of chronic pancreatitis. Br J Surg 1988; 75:1129-33. [PMID: 3208049 DOI: 10.1002/bjs.1800751125] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Fifty-eight consecutive surgical pancreatic resections for chronic pancreatitis were examined. Eight cases were identified with obstructive pancreatopathy; all underwent pancreato-duodenectomy. Histological examination revealed that obstruction in three cases was due to duodenal wall cysts, and in two patients it was associated with pancreas divisum (the accessory papilla was obstructed by a neuroendocrine tumour in one case and by ectopic pancreatic tissue in the other). One case each was due to obstruction of an anomalous duct by vegetable matter, to segmental pancreatitis, and to an intraductal carcinoma. Obstructive pancreatitis has many causes and diligent pre-operative assessment is required as surgical resection may be beneficial. Special efforts should be made to identify ductal anomalies, duodenal cysts, ectopic pancreatic tissue, and small ampullary tumours of exocrine and endocrine origin in order to define the aetiology of pancreatitis.
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Affiliation(s)
- J R Lowes
- Department of Gastroenterology, Middlesex Hospital, London, UK
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30
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Hasan AH, Moule B, Carter DC. Duodenal diverticula and jaundice: percutaneous transhepatic cholangiography may be misleading. Br J Surg 1988; 75:490-1. [PMID: 3134075 DOI: 10.1002/bjs.1800750529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- A H Hasan
- University Department of Surgery, Royal Infirmary, Glasgow, UK
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31
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Neoptolemos JP, Talbot IC, Carr-Locke DL, Shaw DE, Cockleburgh R, Hall AW, Fossard DP. Treatment and outcome in 52 consecutive cases of ampullary carcinoma. Br J Surg 1987; 74:957-61. [PMID: 3664230 DOI: 10.1002/bjs.1800741025] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The results of treatment and outcome in 52 consecutive patients presenting to Leicester from 1972 to 1984 are presented. The number of patients diagnosed increased from two per year before the introduction of duodenoscopy to nearly five per year afterwards. Endoscopic drainage (ED) was attempted in 21 patients with a success rate of 81 per cent. In eight cases ED was used pre-operatively and in the remainder as definitive treatment. Twenty-four patients had a Whipple's resection (12.5 per cent mortality), four patients had a local resection (no deaths), ten patients had surgical bypass (60 per cent mortality) and thirteen patients had ED alone (23 per cent mortality). The major risk factor score was significantly greater in patients undergoing surgical bypass compared with Whipple's resection. Age and risk factor scores were significantly greater in patients who had ED drainage alone than in surgical patients. The 5 year survival rate for resection was 56 per cent versus 13 per cent for drainage procedures (P less than 0.001). Survival in resection cases was directly related to the degree of tumour differentiation and a new staging system. It is proposed that all patients with ampullary tumours should have endoscopic biopsy followed by ED; Whipple's resection remains the surgical treatment of choice.
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