title: The use of endoscopic ultrasonography to reduce the cost of treating ampullary tumors.
abstract: BACKGROUND
  Local excision of selected ampullary tumors may result in the same benefit as Whipple resection with less morbidity and mortality. The purpose of this study was to determine if endoscopic ultrasonography could aid in the selection of patients for local resection and to determine if there was a significant cost difference between the two surgical procedures.
  
  
  METHODS
  In this retrospective study of 32 patients who underwent surgery for ampullary tumors, endoscopic ultrasonography staging was performed in 18 patients. Resected specimens were used to determine pathologic staging. Local disease was defined as stage T2N0 or less. Cost data were available for 20 patients.
  
  
  RESULTS
  The sensitivity and specificity of endoscopic ultrasonography for differentiating local from advanced ampullary tumors were both 83%. The median total cost for a local resection was $9314 versus $16,017 for a Whipple resection (p < 0.0017).
  
  
  CONCLUSIONS
  Endoscopic ultrasonography is an effective tool for identifying patients with localized ampullary tumors. The cost of a local resection for ampullary tumors is significantly less than that of a Whipple resection. The use of endoscopic ultrasonography to select patients for local resection may be a cost-effective technique in the management of patients with ampullary tumors.
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Quirk
authors.forename: D W
authors.initials: DW
authors.lastname: Rattner
authors.forename: C
authors.initials: C
authors.lastname: Fernandez-del Castillo
authors.forename: A L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: W R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000601:surgery; D003937:Diagnosis, Differential; D019160:Endosonography / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013514:Surgical Procedures, Operative / Q000191:economics*