Clin Endosc.  2014 Mar;47(2):174-177. 10.5946/ce.2014.47.2.174.

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

• Okano N
• Igarashi Y
• Hara S
• Takuma K
• Kamata I
• Kishimoto
• Mimura T
• Ito K
• Sumino Y

• KMID: 2049005
• DOI: http://doi.org/10.5946/ce.2014.47.2.174

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.

Keyword

Ampulla of Vater; Endosonography; Intraductal ultrasonography; Endoscopic papillectomy; Endoscopic snare excision

MeSH Terms

Adenoma
Ampulla of Vater*
Classification
Diagnosis
Endosonography*
Humans
SNARE Proteins
Ultrasonography*
SNARE Proteins

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