title: Magnified endoscopic observation using narrow-band imaging of periampullary adenoma in a patient with familial adenomatous polyposis.
abstract: BACKGROUND
  Adenoma of the major papilla carries a relatively high risk of malignant transformation to carcinoma, the leading cause of death in patients with familiar adenomatous polyposis (FAP) after colectomy.
  
  
  METHODS
  A 35-year-old man had undergone prophylactic colectomy for FAP 3 years earlier. On the forward-viewing and side-viewing endoscopy done for surveillance, the overlying mucosa of the major papilla showed even granularity. On magnifying duodenoscopy using a narrow-band system (NBI), which uses modified optical filters and yields clear images of fine surface structures on the mucosal layer, a compact formation of round pits was seen in the affected ampulla. The microvascular architecture on NBI magnification showed no abnormalities, such as dilated, tortuous or network-like vessels, suggestive of malignancy. On endoscopic retrograde pancreaticocholangiography there was no intraductal growth, and endoscopic ultrasonography showed confinement to the mucosal layer. The ampullary lesion was completely resected using endoscopic snare papillectomy. Histopathological examination of the removed specimen showed tubular adenoma without malignant foci. The patient's post-treatment course was uneventful and without complications, and no local recurrence was noted on repeat endoscopy.
  
  
  CONCLUSIONS
  Thus, endoscopic surveillance and removal of ampullary adenomas appear to be justified.
authors: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
authors: Takushi
authors: T
authors: Yamao
authors: Hajime
authors: H
authors: Isomoto
authors: Naoyuki
authors: N
authors: Yamaguchi
authors: Jun
authors: J
authors: Irie
authors: Yuki
authors: Y
authors: Ito
authors: Yujiro
authors: Y
authors: Nakashima
authors: Saburo
authors: S
authors: Shikuwa
authors: Yohei
authors: Y
authors: Mizuta
authors: Shigeru
authors: S
authors: Kohno
authors: Sachiko
authors: S
authors: Imamura
authors: Masaki
authors: M
authors: Yamakawa
authors: Fumihiko
authors: F
authors: Fujita
authors: Tomayoshi
authors: T
authors: Hayashi
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D003082:Colectomy; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004384:Duodenoscopy / Q000379:methods*; D006801:Humans; D008297:Male