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ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 84-89

Can endoscopic ultrasound-guided fine needle aspiration offer clinical benefit for tumors of the ampulla of vater? -An initial study


1 Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya; 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

Correspondence Address:
Kenji Yamao
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.7178/eus.02.006

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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.


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