Characteristic endoscopic ultrasound findings of ampullary lesions that predict the need for surgical excision or endoscopic ampullectomy

Rejeski, Jared; Kundu, Sarba; Hauser, Matthew; Conway, Jason; Evans, John A.; Pawa, Rishi; Mishra, Girish

doi:10.4103/2303-9027.183978

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…Moreover EUS helps to evaluate the depth of the tumor "T" compromise, the presence of lymph nodes "N" and vascular compromise is also evaluated. The FNA-FNB of the pancreatic mass and regional lymph nodes for cytology is occasionally required to con rm the ndings or to plan for a neoadjuvant or palliative therapy [10] This prospective cohort study included 24 patients (Table 1). Our research revealed that PC is common in patients older than 56 years old and this agrees with Michael et al [11] who said that the risk of developing pancreatic cancer increases as people age.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Prediction of The Operability of Pancreatic Carcinoma

Abdalla¹,

Abdellatif²,

Safwat³

et al. 2021

Preprint

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This work discussed the best diagnostic modility for early detection of pancreatic cancer compared to final diagnosis reached by histopathological examination. The present study was constructed by doing imaging modalities computed tomography (CT) and endoscopic ultrasonography (EUS) on 24 patients admitted to surgery department in the faculty of medicine with suspected pancreatic malignancy. As regard masses diameters detected by each modality, EUS was found to be superior to CT in detection of masses less than 20mm in diameter. According to the mass nature, those found in the head region tended to be malignant more frequently than the body and tail, Moreover, solid heterogeneous masses also were more likely to be malignant than the cystic ones as detected by the imaging modalities, with higher accuracy of EUS than with CT. EUS showed more accurate information as regards lymph node involvement and vascular invasion than CT. All of which affected the assessment of resectability of pancreatic masses. On head-to-head comparison, EUS appeared to perform better than CT scan in respect to nodal staging. Based on these results, we conclude that EUS staging should be the standard of care along with state of the art CT scan for the preoperative evaluation of patients with pancreatic cancer. However, large, prospective, multicenter studies directly comparing the accuracy of linear EUS vs. new generation CT scanners are still needed.

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Section: Resultsmentioning

confidence: 99%

Preoperative Prediction of The Operability of Pancreatic Carcinoma

Abdalla¹,

Abdellatif²,

Safwat³

et al. 2021

Preprint

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“…1). Linear array EUS was used in all patients to evaluate and visualize depth of invasion as well as the intraductal invasion of the tumor and locoregional lymph node status 22–26…”

Section: Methodsmentioning

confidence: 99%

“…Linear array EUS was used in all patients to evaluate and visualize depth of invasion as well as the intraductal invasion of the tumor and locoregional lymph node status. [22][23][24][25][26] We performed endoscopic en bloc resection using a regular oval snare, without saline injection, which is a controversial practice and may cause difficulties during the placement of the snare to achieve an adequate en bloc resection. 27,28 Resection was performed with Endocut mode setting on the electrosurgical generator because the incidence of bleeding seems lower when compared with resection using a cutting current.…”

Section: Technical Detailsmentioning

confidence: 99%

Safety of Endoscopic Snare Ampullectomy for Adenomatous Ampullary Lesions: Focus on Pancreatic Stent Placement to Prevent Pancreatitis

Gambitta¹,

Aseni

Villa

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Ampullary tumors, although relatively uncommon, are increasingly diagnosed due to ongoing progress in imaging technology and the diagnostic accuracy of endoscopic ultrasound and magnetic resonance cholangiopancreatography. Endoscopic ampullectomy (EA) has become the preferred treatment option over surgery due to its lower morbidity for benign ampullary adenomas. This study aims to evaluate the efficacy, safety, and outcome of EA in 30 patients with benign-appearing ampullary lesions with particular emphasis on the accuracy of preampullectomy histology and technical details of the pancreatic duct drainage to prevent postprocedural pancreatitis.Materials and Methods: Data from a cohort of 30 patients who underwent EA were retrospectively analyzed. Histologic characteristics of the ampullomas, accuracy of histology of pre-EA biopsy specimen, safety of the procedure, recurrence rate, as well as the clinical outcome of all patients, are analyzed and discussed.Results: Endoscopic resection was successful as a definitive treatment in 25 patients (83.3%). Five patients required additional surgery. In 8 patients, a definitive histologic specimen revealed an adenocarcinoma (3 in situ and 5 invasive). The diagnostic accuracy obtained by preresection biopsy specimen was low (0.70). Pancreatic duct stent placement after snare resection was unsuccessful in 9 patients, and 3 of them developed pancreatitis after EA.Conclusions: EA appears to be a relatively safe alternative to surgery as the first therapeutic option for selected patients with benignappearing ampullary adenomas. A correct preoperative evaluation by endoscopic ultrasound and magnetic resonance cholangiopancreatography can help to define the anatomy of the pancreatic duct to improve the success rate of pancreatic stent placement which seems to offer a protective role in the prevention of postprocedural pancreatitis.

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“…Accuracy in determining resectability of ampullary and pancreatic cancers has been reported as 72%[ 35 ]. Rejeski et al [ 36 ] reported a set of EUS findings which detected ampullary tumours requiring surgery rather than EP with a sensitivity of 97.1%, although this was not prospectively validated on an independent data sample.…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

Surgical ampullectomy: A comprehensive review

Scroggie¹,

Mavroeidis²

2021

WJGS

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Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system. They are typically diagnosed at an earlier stage than other types of tumours in this region, due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct. Consequently, many are potentially curable by excision. Surgical ampullectomy (SA) (or transduodenal ampullectomy) for an ampullary tumour was first described in 1899, but was soon surpassed by pancreatoduodenectomy (PD), which offered a more extensive resection resulting in a lower risk of recurrence. Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy (EP), particularly for adenomas and even early cancers. The vast majority of resectable ampullary tumours are now treated using either PD or EP. However, SA continues to play a role in specific circumstances. Many authors have suggested specific indications for SA based on their own data, practices, or interpretations of the literature. However, certain issues have attracted controversy, such as its use for early ampullary cancers. Consequently, there has been a lack of clarity regarding indications for SA, and no evidence-based consensus guidelines have been produced. All studies reporting SA have employed observational designs, and have been heterogeneous in their methodologies. Accordingly, characteristics of patients and their tumours have differed substantially across treatment groups. Therefore, meaningful comparisons of clinical outcomes between SA, PD and EP have been elusive. Nevertheless, it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival, hence its role in this setting warrants further clarification, while it can also be useful in the management of specific benign entities. Whilst the commissioning of a randomised controlled trial seems unlikely, well-designed observational studies incorporating adjustments for confounding variables may become the best available comparative evidence for SA, potentially informing the eventual development of consensus guidelines. In this comprehensive review, we explore the role of SA in the modern management of ampullary lesions.

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Characteristic endoscopic ultrasound findings of ampullary lesions that predict the need for surgical excision or endoscopic ampullectomy

Cited by 11 publications

References 23 publications

Preoperative Prediction of The Operability of Pancreatic Carcinoma

Preoperative Prediction of The Operability of Pancreatic Carcinoma

Safety of Endoscopic Snare Ampullectomy for Adenomatous Ampullary Lesions: Focus on Pancreatic Stent Placement to Prevent Pancreatitis

Surgical ampullectomy: A comprehensive review

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