Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2011; 3(11): 220-224
Published online Nov 16, 2011. doi: 10.4253/wjge.v3.i11.220
Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma
Mohd Talha Noor, Kim Vaiphei, Birinder Nagi, Kartar Singh, Rakesh Kochhar
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
Author contributions: Singh K designed the study; Noor MT and Kochhar R designed the study and wrote the paper; Vaiphei K reported the histology in all the cases; Nagi B reviewed the radiology of all the cases.
Correspondence to: Rakesh Kochhar, MD, DM, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. dr_kochhar@hotmail.com
Telephone: +91-172-2756608 Fax: +91.172-2744401
Received: February 23, 2011
Revised: September 23, 2011
Accepted: October 18, 2011
Published online: November 16, 2011
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.

Keywords: Carcinoma, Periampullary, Papillotomy, Needle knife, Endoscopic ultrasound, Endoscopy