Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas

Azih, Lilian C.; Broussard, Brett L.; Phadnis, Milind A.; Heslin, Martin J.; Eloubeidi, Mohamad A.; Varadarajulu, Shayam; Arnoletti, J. Pablo

doi:10.3748/wjg.v19.i4.511

Cited by 43 publications

(31 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In previous series, EUS understaged invasion of the duodenal muscularis propria, ranging from 8% to 15%. 5,10 Our observations suggest that EUS is more likely to understage ampullary lesions, perhaps due to missing focal invasion of the muscularis propria that is only identified by histopathological analysis of the resected specimen.…”

Section: Discussionmentioning

confidence: 80%

See 1 more Smart Citation

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Ridtitid¹,

Schmidt²,

Al‐Haddad³

et al. 2015

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection. (Gastrointest Endosc 2015;81:380-8.)

show abstract

Section: Discussionmentioning

confidence: 80%

“…Although several studies showed the reliability of EUS for T staging of ampullary neoplasms, these were limited by small sample size, heterogeneity of study design (combining both duodenal and ampullary lesions), or limited comparative analysis of intraductal extension with ERCP and surgical pathology. 5,8,10 …”

mentioning

confidence: 99%

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Ridtitid¹,

Schmidt²,

Al‐Haddad³

et al. 2015

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

show abstract

“…EUS is a useful adjunct to ERCP to assess for infiltration of the periampullary wall layers and pancreatobiliary ducts but it does not have to be universally incorporated into the diagnostic evaluation of an ampullary adenoma (27,(32)(33)(34)(35)(36)(37)(38)(39). The precise role of EUS in the management of ampullary adenomas is unclear.…”

Section: Endoscopic Ultrasound (Eus)mentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

show abstract

“…EUS, in conjunction with ERCP, allows to assess for infiltration of the periampullary wall layers and pancrea tobiliary ducts but, it does not have to be universally incorpored into the diagnostic evaluation of an ampullary adenoma [45,[50][51][52][53][54][55][56][57] . The use of EUS in the assessment of AA is undefined.…”

Section: Eusmentioning

confidence: 99%

Endoscopic management of adenomatous ampullary lesions

Espinel¹

2015

WJM

View full text Add to dashboard Cite

Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented. Core tip: Adenomatous ampullary lesions are rare. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS) have changed the management of patients with these lesions. Endoscopic ampullectomy is a technique that has revolutionized the treatment of these lesions avoiding potential complications of surgery. We herein discuss the epidemiology, the role of EUS in the local staging and the role of endoscopy in the treatment of the adenomatous ampullary neoplasms.Espinel J, Pinedo E, Ojeda V, Guerra del Rio M. Endoscopic management of adenomatous ampullary lesions. World J REVIEW

show abstract

Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas

Abstract: EUS accurately predicts the depth of mucosal invasion in suspected benign ampullary and duodenal adenomas. These patients can safely undergo endoscopic or local resection.

Cited by 43 publications

References 23 publications

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Endoscopic ampullectomy: A technical review

Endoscopic management of adenomatous ampullary lesions

Contact Info

Product

Resources

About