THE USE OF ENDOSCOPIC ULTRASONOGRAPHY TO REDUCE THE COST OF TREATING AMPULLARY TUMORS

Background: Local excision of selected ampullary tumors may result in the same benefit as Whipple resection with less morbidity and mortalit y, The purpose of this study was to determine if endoscopic ultrasonog raphy could aid in the selection of patients for local resection and t o determine if there was a significant cost: difference between the tw o surgical procedures, Methods: In this retrospective study of 32 pati ents who underwent surgery for ampullary tumors, endoscopic ultrasonog raphy staging was performed in 18 patients, Resected specimens were us ed to determine pathologic staging. Local disease was defined as stage T2NO or less, Cost data were available for 20 patients. Results: The sensitivity and specificity of endoscopic ultrasonography for differen tiating local from advanced ampullary tumors were both 83%. The median total cost for a local resection was $9314 versus $16,017 for a Whipp le resection (p < 0.0017). Conclusion: Endoscopic ultrasonography is a n effective tool for identifying patients with localized ampullary tum ors. The cost of a local resection for ampullary tumors is significant ly less than that of a Whipple resection. The use of endoscopic ultras onography to select patients for local resection may be a cost-effecti ve technique in the management of patients with ampullary tumors.