title: Characteristic endoscopic ultrasound findings of ampullary lesions that predict the need for surgical excision or endoscopic ampullectomy.
abstract: OBJECTIVE
  The management of ampullary lesions has evolved to include endoscopic ampullectomy (EA) as a curative approach to cancers of the ampulla of Vater. With this change comes a need to risk-stratify patients at initial diagnosis.
  
  
  METHODS
  Patients with verified ampullary lesions (N = 50) were analyzed in a case-control design. We evaluated endoscopic ultrasound (EUS) data to define characteristics that yield a high sensitivity in selecting candidates for EA.
  
  
  RESULTS
  Using data from previously published studies yielded a sensitivity of 0.765 in appropriately identifying the 34 surgical cases. Expanding these characteristics increased the sensitivity of EUS to 0.971 in identifying surgical candidates. Additionally, of advanced disease cases, the expanded characteristics correctly identified these cases with a sensitivity of 1.0-improved over 0.708 using prior published data.
  
  
  CONCLUSIONS
  EA should be strongly considered if ampullary lesions are found to fit the following characteristics after EUS evaluation: lesion size <2.5 cm, invasion ≤4 mm, pancreatic duct dilatation ≤3 mm, ≤T1 lesion, no lymph nodes present, and no ductal stent in place. Furthermore, EUS data can be used to identify all high-risk lesions. With these characteristics identified, clinicians are better able to risk-stratify patients using EUS as either appropriate for or too high-risk for endoscopic resection.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Jared J
authors.initials: JJ
authors.lastname: Rejeski
authors.affiliation: Department of Gastroenterology, Hugh Chatham Memorial Hospital, Elkin, North Carolina, USA.
authors.forename: Sarba
authors.initials: S
authors.lastname: Kundu
authors.affiliation: Information Systems, Surgical Services, Winston-Salem, North Carolina, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hauser
authors.affiliation: Department of Internal Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Conway
authors.affiliation: Department of Internal Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Evans
authors.affiliation: Department of Internal Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Pawa
authors.affiliation: Department of Internal Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Girish
authors.initials: G
authors.lastname: Mishra
keywords: Ampullary adenocarcinoma; ampullary adenoma; ampullary lesion; ampullary mass; endoscopic ampullectomy (EA); endoscopic ultrasound (EUS); surgical ampullectomy