Indication of Endoscopic Papillectomy for Tumors of the Ampulla of Vater utility of EYS/iIDUS in Diagnosis and Their Limitations

Abstract

Background and Aim: We had studied the preoperative diagnostic yield of EUS/IDUS and the postoperative histological diagnoses of the ampulla of Vater tumors. Patients and Methods: We have diagnosed 44 patients with tumors of the ampulla of Vater of whom 30 underwent EP or other resection therapy (EP in 14, pancretoduodenectomy in 15, surgical papillectomy in 1 patient). They were diagnosed histologically by adenoma in 13, carcinoma in adenoma in 2 and carcinoma in 15 cases. As for carcinomas 4 were staged as T1, 7 as T2, 4 as T3, respectively. There were following study points: 1) accuracy rate between preoperative biopsy and postoperative histological diagnosis; 2) accuracy of EUS/IDUS in T staging; 3) efficacy in diagnosing the tumor extension into the bile duct and pancreatic duct. In our institution EP is indicated for exposed type of adenoma or carcinoma in adenoma which has no signs of invasion to duodenal muscularis layer and to pancreas as well as which has no signs of tumor extension into the bile and pancreatic duct. We had been investigating appropriateness of the indication too. Results: a) In adenomas, the accuracy rate between preoperative biopsy and postoperative histology was 76.9% (10/13).In adenocarcinomas, the accuracy rate was 92.9% (13/14). b) T staging by EUS/IDUS was accurate in 4 (66.7%) of 6 cases preoperatively diagnosed as T1. In 5 cases preoperatively recognized as T2, the correct diagnosis was established in 4 cases (80%) and in 4 cases of stage T3 was preoperative diagnosis accurate in 3 patients (75%). c) While the accuracy of diagnosing the absence of tumor extension into the bile duct was 100% (7/7), whereas the positivity of that was low as 50% (6/12), indicating a tendency to upstaging. The accuracy of diagnosing the presence of tumor extension into the pancreatic duct was 100% (2/2), whereas the negativity of that was 92.9% (13/14). EP was performed in 14 patients, of which 12 were cases of adenoma and 2 cases of carcinoma in adenoma. En bloc resection was performed in 13 cases and piecemeal resection in 1 case. No recurrence has been found in any of these cases. Conclusion: While T2 or more advanced tumors can be diagnosed by EUS/IDUS, diagnosis of T1 by these modalities is not necessarily easy. EP has been indicated for exposed type adenomas with no signs of tumor extension, and for carcinomas in adenoma with no signs of pancreato-duodenal invasion. Background and Aim: We had studied the preoperative diagnostic yield of EUS/IDUS and the postoperative histological diagnoses of the ampulla of Vater tumors. Patients and Methods: We have diagnosed 44 patients with tumors of the ampulla of Vater of whom 30 underwent EP or other resection therapy (EP in 14, pancretoduodenectomy in 15, surgical papillectomy in 1 patient). They were diagnosed histologically by adenoma in 13, carcinoma in adenoma in 2 and carcinoma in 15 cases. As for carcinomas 4 were staged as T1, 7 as T2, 4 as T3, respectively. There were following study points: 1) accuracy rate between preoperative biopsy and postoperative histological diagnosis; 2) accuracy of EUS/IDUS in T staging; 3) efficacy in diagnosing the tumor extension into the bile duct and pancreatic duct. In our institution EP is indicated for exposed type of adenoma or carcinoma in adenoma which has no signs of invasion to duodenal muscularis layer and to pancreas as well as which has no signs of tumor extension into the bile and pancreatic duct. We had been investigating appropriateness of the indication too. Results: a) In adenomas, the accuracy rate between preoperative biopsy and postoperative histology was 76.9% (10/13).In adenocarcinomas, the accuracy rate was 92.9% (13/14). b) T staging by EUS/IDUS was accurate in 4 (66.7%) of 6 cases preoperatively diagnosed as T1. In 5 cases preoperatively recognized as T2, the correct diagnosis was established in 4 cases (80%) and in 4 cases of stage T3 was preoperative diagnosis accurate in 3 patients (75%). c) While the accuracy of diagnosing the absence of tumor extension into the bile duct was 100% (7/7), whereas the positivity of that was low as 50% (6/12), indicating a tendency to upstaging. The accuracy of diagnosing the presence of tumor extension into the pancreatic duct was 100% (2/2), whereas the negativity of that was 92.9% (13/14). EP was performed in 14 patients, of which 12 were cases of adenoma and 2 cases of carcinoma in adenoma. En bloc resection was performed in 13 cases and piecemeal resection in 1 case. No recurrence has been found in any of these cases. Conclusion: While T2 or more advanced tumors can be diagnosed by EUS/IDUS, diagnosis of T1 by these modalities is not necessarily easy. EP has been indicated for exposed type adenomas with no signs of tumor extension, and for carcinomas in adenoma with no signs of pancreato-duodenal invasion.