title: Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for tumors of the ampulla of vater? -an initial study.
abstract: OBJECTIVE
  No previous studies have described endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) only for intra-ampullary lesions of the papilla of Vater. We aimed to examine whether EUS-FNA can be used to diagnose such lesions.
  
  
  METHODS
  This study included a subset of 10 consecutive patients in whom EUS-FNA targeted the ampulla of Vater. All the patients underwent biopsy and/or brushing cytology under endoscopic retrograde cholangiopancreatography (ERCP) prior to EUS-FNA. The final diagnosis was based on pathological examinations of specimens obtained by surgical resection or clinical follow-up more than 1 year in case of evidence of benign lesions.
  
  
  RESULTS
  Tissues from the ampulla of Vater could be obtained by EUS-FNA for all 10 patients. The final diagnosis was papillitis (n = 7) and intra-ampullary carcinoma (n = 3). Carcinoma of the ampulla of Vater showed neither exposure on the duodenal mucosal surface nor invasion to the pancreas. The diagnostic accuracy of surface biopsy with duodenoscopy, and intra-ampullary biopsy and/or brush cytology with ERCP and/or intra-ampullary biopsy after endoscopic sphincterotomy (EST) in distinguishing between benign and malignancy was 70%. The diagnostic accuracy of EUS-FNA was 100%. No complications associated with EUS-FNA were encountered in this study.
  
  
  CONCLUSIONS
  EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST.
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan ; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kondo
authors.affiliation: Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Waki
authors.initials: W
authors.lastname: Hosoda
authors.affiliation: Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), Delhi, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.affiliation: Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
keywords: ampulla of Vater; carcinoma of ampulla of Vater; endoscopic ultrasound; fine needle aspiration, intra-ampullary carcinoma; papillitis