Endoscopic diagnosis for ampullary neoplasm

Abstract

The recent widespread use of esophago-gastro-duodenoscopy has contributed to early diagnosis of ampullary neoplasm. Although duodenoscopic findings are important for diagnosis, endoscopic biopsy is essential for a definitive diagnosis. Endoscopic ultrasonography-guided fine needle aspiration or endoscopic biopsy after endoscopic sphincterotomy is useful for diagnosis in selected patients with suspected non-exposed-tumor type. Pancreaticoduodenectomy remains a standard treatment for ampullary neoplasm. Reports on the usefulness of reduction treatment such as endoscopic papillectomy have recently increased. Accurate preoperative tumor staging is mandatory for the indication for such treatments. Both EUS and intraductal US of the bile duct can provide useful information for precise tumor staging of ampullary neoplasm. However, even by these modalities differential diagnosis between mucosal cancer and od cancer (depth of tumor: od) remains challenging.