Characteristic Endoscopic Ultrasound Findings of Ampullary Lesions That Predict the Need for Surgical Excision or Endoscopic Ampullectomy

Overview

Journal Endosc Ultrasound

Date 2016 Jul 8

PMID 27386476

Citations 3

Authors

Jared J Rejeski

Sarba Kundu

Matthew Hauser

Jason D Conway

John A Evans

Rishi Pawa

Girish Mishra

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: The management of ampullary lesions has evolved to include endoscopic ampullectomy (EA) as a curative approach to cancers of the ampulla of Vater. With this change comes a need to risk-stratify patients at initial diagnosis.

Materials And Methods: Patients with verified ampullary lesions (N = 50) were analyzed in a case-control design. We evaluated endoscopic ultrasound (EUS) data to define characteristics that yield a high sensitivity in selecting candidates for EA.

Results: Using data from previously published studies yielded a sensitivity of 0.765 in appropriately identifying the 34 surgical cases. Expanding these characteristics increased the sensitivity of EUS to 0.971 in identifying surgical candidates. Additionally, of advanced disease cases, the expanded characteristics correctly identified these cases with a sensitivity of 1.0-improved over 0.708 using prior published data.

Conclusion: EA should be strongly considered if ampullary lesions are found to fit the following characteristics after EUS evaluation: lesion size <2.5 cm, invasion ≤4 mm, pancreatic duct dilatation ≤3 mm, ≤T1 lesion, no lymph nodes present, and no ductal stent in place. Furthermore, EUS data can be used to identify all high-risk lesions. With these characteristics identified, clinicians are better able to risk-stratify patients using EUS as either appropriate for or too high-risk for endoscopic resection.

Citing Articles

Surgical ampullectomy: A comprehensive review.

Scroggie D, Mavroeidis V World J Gastrointest Surg. 2021; 13(11):1338-1350.

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Endoscopic Ultrasonography is a Promising Tool for Preoperative Prediction of the Operability of Pancreatic Carcinoma.

Abdellatif T, Safwat K, Elmenshawy H, Abdalla W, Naguib S J Gastrointest Cancer. 2021; 53(1):197-203.

PMID: 33411255 DOI: 10.1007/s12029-020-00567-w.

Transduodenal ampullectomy for ampullary tumors.

Mansukhani V, Desai G, Mouli S, Shirodkar K, Shah R, Palepu J Indian J Gastroenterol. 2017; 36(1):62-65.

PMID: 28054258 DOI: 10.1007/s12664-016-0726-0.

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