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Comparative Study
. 2015 Feb;81(2):380-8.
doi: 10.1016/j.gie.2014.08.005. Epub 2014 Oct 5.

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Wiriyaporn Ridtitid  1 , Suzette E Schmidt  2 , Mohammad A Al-Haddad  2 , Julia LeBlanc  2 , John M DeWitt  2 , Lee McHenry  2 , Evan L Fogel  2 , James L Watkins  2 , Glen A Lehman  2 , Stuart Sherman  2 , Gregory A Coté  3
Affiliations
Comparative Study

Performance characteristics of EUS for locoregional evaluation of ampullary lesions

Wiriyaporn Ridtitid et al. Gastrointest Endosc. 2015 Feb.

Abstract

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.

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Figures

Figure 1
Figure 1
Intraductal extension (arrowheads) of ampullary adenocarcinoma by EUS. CBD, common bile duct.
Figure 2
Figure 2
Distal bile duct stricture (arrowheads) secondary to intraductal extension of ampullary lesion by ERCP.
Figure 3
Figure 3
Patient cohort: EUS for ampullary lesions between 1998 and 2012.
See this image and copyright information in PMC

Comment in

References

    1. Ceppa EP, Burbridge RA, Rialon KL, et al. Endoscopic versus surgical ampullectomy: an algorithm to treat disease of the ampulla of Vater. Ann Surg. 2013;257:315–22. - PubMed
    1. Ridtitid W, Tan D, Schmidt SE, et al. Endoscopic papillectomy: risk factors for incomplete resection and recurrence during long-term follow-up. Gastrointest Endosc. 2014;79:289–96. - PMC - PubMed
    1. Bohnacker S, Seitz U, Nguyen D, et al. Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth. Gastrointest Endosc. 2005;62:551–60. - PubMed
    1. Boix J, Lorenzo-Zuniga V, Moreno de Vega V, et al. Endoscopic resection of ampullary tumors: 12-year review of 21 cases. Surg Endosc. 2009;23:45–9. - PubMed
    1. Ito K, Fujita N, Noda Y, et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007;66:740–7. - PubMed

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