The role of endoscopy in ampullary and duodenal adenomas

Adler, Douglas G.; Qureshi, Waqar; Davila, Raquel E.; Gan, S. Ian; Lichtenstein, David R.; Rajan, Elizabeth; Shen, Bo; Zuckerman, Marc J.; Fanelli, Robert D.; Guilder, Trina Van; Baron, Todd H.

doi:10.1016/j.gie.2006.08.044

Cited by 160 publications

(104 citation statements)

References 46 publications

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“…EUS is useful in the investigation of ampullary and periampullary pathologies because of its capacity to identify small lesions (< 2cm.) more effectively than other imaging technologies [7,28,29] . However, with the present day MDCT & Pancreatic protocol based CT scanning, few periampullary tumours will be missed out, even if small in size.…”

Section: Discussionmentioning

confidence: 99%

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

Saad

Gravante

Andrew

et al. 2015

Journal of Gastroenterology and Hepatology Research

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Periampullary carcinoma has a better prognosis than pancreatic adenocarcinoma. Hence accurate pre -operative staging is essential for avoiding surgical exploration for unresectable tumours. At the same time, operable cases should not be denied curative surgery based on false positive imaging. Hence it is essential that the imaging should have a high positive predictive value. This article makes a case for the utility of EUS in the accurate diagnosis of periampullary cancer, the detection of lymph node metastases and invasion of the Portal/Superior Mesenteric vein as compared to CT scanning. Electronic search of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases was performed from 1982 to May 2009 to identify relevant studies. Articles meeting the criteria were retrieved and studied according to a standard proforma. Data were extracted from the articles into an Excel database and compared. The search revealed 211 published articles. Twenty-one papers matched the selection criteria. Sixteen articles were prospective and five retrospective. The data compared included local staging of the tumour, lymph node and venous involvement. CT scanning remains the initial investigation of choice in the diagnosis and staging of periampullary tumours but EUS might be superior for overall detection of lesions, especially those smaller than 2 cm. Although CT remains the investigation of choice, it is essential that EUS is performed by experienced operators and used when the clinical suspicion is high and CT fails to demonstrate a mass. This could increase the number of early lesions detected and improve the overall prognosis.

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Section: Discussionmentioning

confidence: 99%

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

Saad

Gravante

Andrew

et al. 2015

Journal of Gastroenterology and Hepatology Research

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“…This sequence is a carcinoma development model from adenomatous lesions. Several studies support this theory for ampullary adenocarcinomas such as, for example, the presence of residual adenoma up to 90% of adenocarcinomas ampullary [12], history of adenoma resection in 30% of patients with carcinoma of the ampulla of Vater [13] and the presence of carcinoma in situ in about 40% of the resected adenomas of this [14]. Early screening with endoscopy is an important factor for diagnosis of ampullary lesions in initial stages in patients with FAP.…”

Section: Carcinoma Of Ampulla Of Vater: Carcinogenesis and Immunophenmentioning

confidence: 96%

Carcinoma of Ampulla of Vater: Carcinogenesis and Immunophenotypic Evaluation

Rosa¹,

Peria²,

Brunaldi³

2017

J Clin Epigenet

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“…The role of submucosal injection of saline, which may be combined with epinephrine or methylene blue before ampullectomy, is controversial (6,44,47). Epinephrine and methylene blue may help minimize bleeding and enhance endoscopic visualization of the lesions margins, respectively.…”

Section: Submucosal Injectionmentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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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.

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The role of endoscopy in ampullary and duodenal adenomas

Cited by 160 publications

References 46 publications

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

Carcinoma of Ampulla of Vater: Carcinogenesis and Immunophenotypic Evaluation

Endoscopic ampullectomy: A technical review

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