Spectrum of periampullary lesions and the role of endoscopic retrograde cholangiopancreatography in their diagnosis

Abstract

Context The periampullary area is a hot spot for neoplasia and lesions arising there often obstruct the biliopancreatic stream, so drainage and tissue diagnosis of any suspicious lesion are very important. Aims The aims were to estimate the frequency of different types of periampullary lesions, and assess the diagnostic accuracy of biopsy and brush cytology taken by endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods A prospective study conducted at Assiut University Hospital over a period of 1 year starting from June 2017. The authors enrolled patients presented with clinical and radiological suspicion of periampullary lesions indicating ERCP. Physical, laboratory, and imaging data were recorded and data of ERCP examination as well as results of endoscopic biopsies were studied and compared with the final diagnosis after definitive surgical intervention and/or sufficient follow-up. Statistical Package for the Social Sciences, version 20, IBM. Results During the 1 year, periampullary lesions represented 18.8% of all cases who underwent ERCP (154 out of 818), including 25 cases with distal common bile duct (CBD) stone/s, 40 inflammatory, 15 benign, and 74 malignant lesions. The sensitivity and specificity of grasp biopsy were 67.5 and 70% when any dysplasia was regarded as a malignant lesion and they were 54 and 90% when only high-grade dysplasia was considered malignant. Sensitivity and specificity of brush cytology was 33 and 100%. Conclusion Periampullary area has a high potentiality for neoplastic changes and ERCP-guided biopsy has a reasonable diagnostic yield.