PERIAMPULLARY CARCINOMA DETECTED AFTER SPHINCTEROTOMY

Background/Aims: Although periampullary carcinoma can often be diagnos ed at an early stage because of its strategic location, in a substanti al number of cases (23% to 25% of periampullary carcinoma cases), the papilla can be prominent, but without an identifiable mass or ulcerati on. As a result, duocdenoscopy alone can miss the tumor. In this serie s, the usefulness of sphincterotomy in establishing a diagnosis of per iampullary carcinoma is documented. Materials and Methods: A total of 664 patients, who had clinical, biochemical and/or sonographic evidenc e of pancreaticobiliary disorders underwent endoscopic retrograde chol angiopancreaticography (ERCP) at Hacettepe University Hospital between March 1985 and September 1994. All identified lesions were biopsied. Results: In sixty-six of the 664 patients, a specific periampullary or pancreatic diagnosis could be made. These included 30 cases of pancre atic carcinoma (14 in the head, 15 in the corpus, and 1 in the tail), 10 cases of chronic pancreatitis, 15 cases of periampullary carcinoma and 11 miscellaneous. None of the 15 periampullary carcinomas was demo nstrable by abdominal computed tomography, sonography or pancreatic an giography. In 22, the diagnosis was established immediately by endosco pic visualization of the tumor and biopsy. In the remaining 3, the tum or was visualized as a protruding mass only after a papillatomy was pe rformed. All cases were treated surgically with a pylorus preserving p ancreaticoduodenectomy. No symptoms of dumping were experienced postop eratively. The survival of these 15 patients was good with a mean surv ival of 24.2 months. Conclusions: Careful endoscopic examination of th e periampullary mucosa before and after sphincterotomy is required to identify periampullary carcinoma. A pylorus preserving pancreaticoduod enectomy revealed excellent post-surgical outcome with no post operati ve symptoms of the dumping syndrome.