Are endoscopic procedures able to predict the benignity of ampullary tumors?
BACKGROUND
Malignant ampullary tumors (AT) require pancreatico-duodenectomy (PD) for curative treatment whereas benign AT can be appropriately treated by local resection. This study evaluated the accuracy of endoscopic exploration combining side-viewing duodenoscopy (SVD) with forceps biopsies, endoscopic sphincterotomy (ES), and endoscopic ultrasonography (EUS) to distinguish benign AT from malignant one.


METHODS
Twenty-six patients with AT had preoperative SVD with forceps biopsies, including 9 with ES, and EUS. Nodal status was evaluated by EUS in all patients, but could not evaluate parietal spread in 6 in whom ES was previously done. Results of endoscopic examination were compared with pathologic examination after resection (2 local excisions for 2 benign AT, and 24 PD for 20 malignant and 4 benign AT).


RESULTS
Accuracy of histologic examination of the 26 biopsies of the papilla was 69%. After ES, accuracy of intra-ampullary biopsies was 77%. The EUS had a 75% accuracy for the parietal spread (tumor limited to ampulla or not) and a 69% accuracy for the nodal status. In 11 patients, all explorations were consistent with a benign lesion, but 6 of these patients had a histologically proven malignancy, including one with nodal metastases and two with duodenal involvement.


CONCLUSIONS
Side-viewing duodenoscopy with biopsies, even after ES, combined with EUS is not accurate enough to preoperatively ensure that an AT is benign. Indication for a local resection based on these explorations alone is not safe.
Sauvanet
A
A
Department of Digestive Surgery, Hôpital Beaujon, Clichy, France.
Chapuis
O
O
Hammel
P
P
Fléjou
J F
JF
Ponsot
P
P
Bernades
P
P
Belghiti
J
J
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging; D001706:Biopsy; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D014463:Ultrasonography