New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system.
BACKGROUND
A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases. In the present study, we investigated the ability of magnifying endoscopy with NBI (MENBI) to diagnose and differentiate between benign and malignant ampullary tumors.


METHODS
Fourteen patients, whose ampullas were noted to be significantly enlarged or protruding with conventional endoscopy, were enrolled in the study. Specimens, which were obtained by forceps biopsy, endoscopic papillectomy, and/or surgery, were retrieved for histopathological examination. The correlation between MENBI images and histopathological findings was investigated. MENBI findings were classified as I, oval-shaped villi; II, pinecone/leaf-shaped villi; or III, irregular/nonstructured. In addition, tortuous, dilated, and network-like vessels noted on the ampullary lesions with MENBI were defined as abnormal vessels.


RESULTS
In 6 of 14 patients, the ampullary changes were proven to be inflammatory in forceps biopsy specimens, without any evidence of malignancy after more than 1 year of follow-up. In five patients, ampullary lesions were treated by endoscopic papillectomy, and in three, by pancreatoduodenectomy. All adenomas and adenocarcinomas had type II and/or type III surface structures, and patients whose ampulla had a type I surface structure had only inflammatory or hyperplastic changes. In addition, abnormal vessels were seen only in adenocarcinomas and never in adenomas.


CONCLUSIONS
MENBI has the ability and potential to predict histological characteristics of ampullary lesions.
Uchiyama
Yujiro
Y
Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
Imazu
Hiroo
H
Kakutani
Hiroshi
H
Hino
Shoryoku
S
Sumiyama
Kazuki
K
Kuramochi
Akira
A
Tsukinaga
Shintaro
S
Matsunaga
Kazuhiro
K
Nakayoshi
Takashi
T
Goda
Ken-ichi
K
Saito
Shoichi
S
Kaise
Mitsuru
M
Kawamuara
Muneo
M
Omar
Salem
S
Tajiri
Hisao
H
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D001706:Biopsy; D004379:Duodenal Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D008297:Male; D018715:Microscopy, Video; D008875:Middle Aged; D012189:Retrospective Studies