Endosonographic Preoperative Evaluation for Tumors of the Ampulla of Vater Using Endoscopic Ultrasonography and Intraductal Ultrasonography

Overview

Journal Clin Endosc

Date 2014 Apr 26

PMID 24765600

Citations 13

Authors

Naoki Okano

Yoshinori Igarashi

Seiichi Hara

Kensuke Takuma

Itaru Kamata

Yui Kishimoto

Takahiko Mimura

Ken Ito

Yasukiyo Sumino

Affiliations

Soon will be listed here.

Abstract

Background/aims: In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. This procedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy.

Methods: The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy) who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographic evaluation and pathological diagnosis of these tumors.

Results: The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 50% for pT3-4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3-4 tumors, for an overall accuracy of 80% for T-staging.

Conclusions: EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniques are not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequate for treating adenomas and pTis tumors.

Citing Articles

The Role of Endoscopic Ultrasound in Ampullary Lesion Management.

Stornello C, Cristofori C, Checchin D, de Palo M, Grillo S, Peserico G Diagnostics (Basel). 2024; 14(17).

PMID: 39272640 PMC: 11394035. DOI: 10.3390/diagnostics14171855.

A duodenal ampullary tumor with malignant transformation of papillary polyps: a case report and literature review.

Mo W, Li J, Dai Y, Chen J, Xu X J Int Med Res. 2021; 49(10):3000605211053230.

PMID: 34719989 PMC: 8562643. DOI: 10.1177/03000605211053230.

Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy.

Sato T, Sagami R, Nishikiori H, Tsuji H, Sato K, Daa T Intern Med. 2021; 60(16):2593-2599.

PMID: 33716282 PMC: 8429288. DOI: 10.2169/internalmedicine.6404-20.

Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions.

Wang Z, Liu F, Wang Y, Wang X, Tang P, Li W World J Gastroenterol. 2020; 26(37):5673-5681.

PMID: 33088160 PMC: 7545392. DOI: 10.3748/wjg.v26.i37.5673.

Methods and outcome of the endoscopic treatment of ampullary tumors.

Poley J, Campos S Ther Adv Gastrointest Endosc. 2020; 13:2631774519899786.

PMID: 32030370 PMC: 6977234. DOI: 10.1177/2631774519899786.

References

Menzel J, Hoepffner N, Sulkowski U, Reimer P, Heinecke A, Poremba C . Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT--a prospective, histopathologically controlled study. Gastrointest Endosc. 1999; 49(3 Pt 1):349-57. DOI: 10.1016/s0016-5107(99)70012-x. View

Artifon E, Couto Jr D, Sakai P, da Silveira E . Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest Endosc. 2009; 70(2):290-6. DOI: 10.1016/j.gie.2008.11.045. View

Cannon M, Carpenter S, Elta G, Nostrant T, Kochman M, Ginsberg G . EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc. 1999; 50(1):27-33. DOI: 10.1016/s0016-5107(99)70340-8. View

Norton I, Gostout C, Baron T, Geller A, Petersen B, Wiersema M . Safety and outcome of endoscopic snare excision of the major duodenal papilla. Gastrointest Endosc. 2002; 56(2):239-43. DOI: 10.1016/s0016-5107(02)70184-3. View

Kubo H, Chijiiwa Y, Akahoshi K, Hamada S, Matsui N, Nawata H . Pre-operative staging of ampullary tumours by endoscopic ultrasound. Br J Radiol. 1999; 72(857):443-7. DOI: 10.1259/bjr.72.857.10505006. View

Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, Takasawa O . Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007; 66(4):740-7. DOI: 10.1016/j.gie.2007.03.1081. View

Binmoeller K, Boaventura S, Ramsperger K, Soehendra N . Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc. 1993; 39(2):127-31. DOI: 10.1016/s0016-5107(93)70051-6. View

Chen C, Tseng L, Yang C, Yeh Y, Mo L . The accuracy of endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, computed tomography, and transabdominal ultrasound in the detection and staging of primary ampullary tumors. Hepatogastroenterology. 2002; 48(42):1750-3. View

Nakao A, Harada A, Nonami T, Kishimoto W, Takeda S, Ito K . Prognosis of cancer of the duodenal papilla of Vater in relation to clinicopathological tumor extension. Hepatogastroenterology. 1994; 41(1):73-8. View

10.

Skordilis P, Mouzas I, Dimoulios P, Alexandrakis G, Moschandrea J, Kouroumalis E . Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. BMC Surg. 2002; 2:1. PMC: 101389. DOI: 10.1186/1471-2482-2-1. View

11.

Yasuda K, Mukai H, Cho E, Nakajima M, Kawai K . The use of endoscopic ultrasonography in the diagnosis and staging of carcinoma of the papilla of Vater. Endoscopy. 1988; 20 Suppl 1:218-22. DOI: 10.1055/s-2007-1018179. View

12.

Itoh A, Goto H, Naitoh Y, Hirooka Y, Furukawa T, Hayakawa T . Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc. 1997; 45(3):251-60. DOI: 10.1016/s0016-5107(97)70267-0. View