XXXX of the ampulla of Vater: the endoscopic approach.

@entity5 @entity1 @entity189 @entity3
@entity189 of the ampulla of Vater is a rare @entity5 . Early and accurate diagnosis of @entity189 of the ampulla of Vater will lead to early treatment and subsequent better prognosis. Endoscopy and endoscopic retrograde cholangiopancreaticography (ERCP) has been shown to be one of the best diagnostic modalities. Furthermore an endoscopic biliary drainage procedure can be performed immediately following the diagnostic procedure. The @entity5 may be seen as large, fleshy, friable exophytic growths, as @entity5 into the duodenal wall or as a mass behind the orifice of the papilla, covered with normal duodenal mucosa. Forceps biopsies do not always suffice to show @entity5 . Large snare biopsies often are necessary. Occasionally the final diagnosis of @entity5 can only be made by examination of the surgical resection specimen. @entity5 arising inside the ampulla form a bulge, covered by normal duodenal mucosa. An impacted stone may mimic this picture. Endoscopic papillotomy is then mandatory to make the final diagnosis. Histologic examination of forceps biopsies reveals @entity5 in only 60% of cases. When snare biopsy is used, the diagnostic yield increases to 83%. The optimal treatment of @entity189 of the ampulla of Vater is surgical resection. Preoperative biliary drainage should theoretically be of benefit to the @entity1 . The results of preoperative percutaneous drainage studies are, however, conflicting. @entity189 of the ampulla of Vater is not resectable in 25-50% of the @entity1 because of @entity3 , deep extension of the @entity5 or general contraindications for major surgery. Endoscopic papillotomy or stent placement as a definitive treatment modality should be reserved for poor surgical candidates and for those @entity1 with limited life expectancy due to @entity3 .
