Cancer of the Ampulla of Vater: Current Evaluation and Therapy

Ahmad, Sarah; Adler, Douglas G.

doi:10.3810/hp.2014.12.1158

Cited by 5 publications

(6 citation statements)

References 184 publications

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“…Although there are no specific tumor markers for periampullary tumors, CA19-9 and CEA are often elevated in patients with periampullary tumors and used as a diagnostic indicator in many literatures (16)(17)(18)(19)(20). In 115 patients, CEA and/or CA19-9 were elevated in 44 patients.…”

Section: Diagnostic Accuracy Of Eus Combined With Tumor Markersmentioning

confidence: 99%

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies

Ding

Zhou

et al. 2019

Ann. Transl. Med.

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Background: Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). Methods: From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. Results: The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. Conclusions: EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.

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Section: Diagnostic Accuracy Of Eus Combined With Tumor Markersmentioning

confidence: 99%

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies

Ding

Zhou

et al. 2019

Ann. Transl. Med.

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“…Approximately half of patients with AoV cancer present at an advanced stage. For those who present at an early stage, pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) are recognized as standard treatments [ 6 , 7 , 8 ]. Because the disease generally presents in patients whose age makes surgical procedures risky, only 40% of AoV patients undergo surgical resection [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Oncologic Outcomes between Transduodenal Ampullectomy and Pancreatoduodenectomy in Ampulla of Vater Cancer: Korean Multicenter Study

Hong

Han

Kwon

et al. 2021

Cancers

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This study used multicenter data to compare the oncological safety of transduodenal ampullectomy (TDA) with that of pylorus-preserving pancreatoduodenectomy (PPPD) in early ampulla of Vater (AoV) cancer. Data for patients who underwent surgical resection for AoV cancer (pTis–T2 stage) from January 2000 to September 2019 were collected from 15 institutions. The clinicopathologic characteristics and survival outcomes were compared between the PPPD and TDA groups. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior in the PPPD group was more aggressive than that in the TDA group at all T stages: larger tumor size (p = 0.034), advanced T stage (p < 0.001), aggressive cell differentiation (p < 0.001), and more lymphovascular invasion (p = 0.002). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the two groups when considering all T stages or only the Tis+T1 group. Among T1 patients, PPPD produced significantly better DFS (PPPD vs. TDA, 84.8% vs. 66.6%, p = 0.040) and superior OS (PPPD vs. TDA, 89.1% vs. 68.0%, p = 0.056) than TDA. Lymph node dissection (LND) in the TDA group did not affect DFS or OS (TDA + LND vs. TDA-only, DFS, p = 0.784; OS, p = 0.870). In conclusion, PPPD should be the standard procedure for early AoV cancer.

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“…Большой сосочек двенадцатиперстной кишки (БСДК) -сложная анатомическая структура, представляющая область контакта терминального отдела общего желчного протока, главного панкреатического протока и непосредственно стенки двенадцатиперстной кишки [1]. Этим объясняется разнообразие доброкачественных и злокачественных опухолей БСДК по морфологическому строению [2,3].…”

Section: Introductionunclassified

Diagnosis of Tumors of the Major Duodenal Papilla

Орлова¹,

Scientific²,

Kim³

et al. 2020

EPh

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With the development of endoscopic minimally invasive methods of treatment, endoscopic ultrasonography (EUS) is becoming increasingly relevant in the diagnostic algorithm for examining patients with neoplasms of the major duodenal papilla. Assessment of the exact size of the neoplasm, involvement in the pathological process of the duodenal wall, common bile and main pancreatic ducts, pancreatic parenchyma plays an important role in determining the future management of patients. The introduction of additional techniques such as contrast enhancement (CH-EUS), fine needle puncture (EUS-FNA) contribute to improving the possibility of morphological verification of tumors

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Cancer of the Ampulla of Vater: Current Evaluation and Therapy

Cited by 5 publications

References 184 publications

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies

Comparison of Oncologic Outcomes between Transduodenal Ampullectomy and Pancreatoduodenectomy in Ampulla of Vater Cancer: Korean Multicenter Study

Diagnosis of Tumors of the Major Duodenal Papilla

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