Takeshi Ogura1, Kazuo Hara2, Susumu Hijioka2, Nobumasa Mizuno2, Hiroshi Imaoka2, Yasumasa Niwa3, Masahiro Tajika3, Shinya Kondo3, Tsutomu Tanaka3, Yasuhiro Shimizu4, Waki Hosoda5, Yasushi Yatabe5, Vikram Bhatia6, Kazuhide Higuchi7, Kenji Yamao2. 1. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan ; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan. 2. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. 3. Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan. 4. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 5. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. 6. Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), Delhi, India. 7. 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
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. CONCLUSION: EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST.
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. CONCLUSION: EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST.
Entities:
Keywords:
ampulla of Vater; carcinoma of ampulla of Vater; endoscopic ultrasound; fine needle aspiration, intra-ampullary carcinoma; papillitis
Authors: Ian D Norton; Christopher J Gostout; Todd H Baron; Alex Geller; Bret T Petersen; Maurits J Wiersema Journal: Gastrointest Endosc Date: 2002-08 Impact factor: 9.427
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