THE CONTRIBUTION OF ENDOSCOPIC ULTRA SONOGRAPHY IN AMPULLARY PATHOLOGY

Aims The aim was to show the role of ultrasound endoscopy in the diagnosis of ampullomas.

Methods This was a study spanning a 2-year period during which 09 patients were identified.We evaluated tumor size, tumor wall staging, pancreatic and biliary impact, tumor echogenicity, vascular relationships and the presence of lymphadenopathy.

Results The mean age was 61 years with a predominance of females.The indication for echoendoscopy was a suspicion of ampulloma in imaging in55% of cases, a discovery of uncertain ampullary pathology on duodenoscopy before ERCP in33%,in as part of the etiological assessment of acute pancreatitis in 11%of cases.The tumor was classified as uT1 in44.4%, uT3 in 33.3% , uT2 in11.1%,uT4 in11.1% of cases.The development was endocanal in44.4% of cases; exo ampullary and mixed in 44% and pseudo-tumor in only one case.A22G needle aspiration was performed in 44.5% of cases; the results were in favor of a Vatérien adenocarcinoma in100% of cases;including 2 patients considered uT1 were operated and classified respectively PT3bN1M and PT2 on an operative specimen with absence of vascular emboli.A puncture by biopsy forceps was also performed in55.5% of cases, the results were in favor of a Vatérien adenocarcinoma in60%,considered successivelyuT2,uT3 in two cases and which were operable and classified respectively pT3aNxM, pT2N0MX and pT1N0Mx on the surgical specimen.The forceps biopsy came back negative in 40% of cases.

Conclusions: Endoscopic ultra sonography (EUS) is today the best tool for examining the ampullary region.In our study we had 100% of positive cases on FNA while the clamp was positive in 60% of cases.

Publication History

Article published online:
14 April 2022