The Contribution of the Endoscopic Ultrasound (EUS) in Ampullary Tumors

Abstract

Introduction: the ampullary region is the region of the small intestine that presents the highest frequency of neoplastic transformation and malignancy. Endoscopic ultrasound is nowadays the best tool to examine the papilla and to perform the assessment of locoregional extension of ampullary and peri-ampullary tumors. It also makes it possible to establish the TNM classification with greater sensitivity than other imaging techniques. The aim of this work is to describe the interest of echo endoscopy in ampullary tumors.

Methods Data: A 15-month restrospective study (August 2019-November 2020) during which 10 patients were enrolled. We evaluated papilla appearance, tumor parietal staging, associated lesions and the histological results.

Results: From August 2019 to November 2020, 10 patients with ampullary tumors were defined. 60% of an enlarged tumor papilla (n = 6), 20% an hypoechoic and homogenous thickening of the papilla, without invasion of the duodenal wall (n = 2), papilla was normal in 20% (n = 2). 3 patients (30%) had a dilated CBD (common bile duct) with a choledocolithiasis, 5 (50%) patients had a gallblader stones. However, EUS revealed an isolated gallstone impaction at the ampulla of Vater in 2 patient (20%) without tumor. 8 patients (80%) underwent a 19G or 22G fine needle aspiration (FNA): Histopathological examination revealed 3 (37%) adenoma with low grade dysplasia, 3 (37%) invasive carcinoma and 2 papillitis (25%). By EUS, 3 (50% ) ampullary lesions were staged as uT2, 2 (33 %) as T1sm, and 1 (16 %) as T3

Conclusion: EUS-FNA for ampulla of Vater may be safely and accurately performed, and should be considered as a diagnostic modality before EST(endoscopic sphincterotomy). Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important