ARE ENDOSCOPIC PROCEDURES ABLE TO PREDICT THE BENIGNITY OF AMPULLARY TUMORS

BACKGROUND: Malignant ampullary tumors (AT) require pancreatico-duoden ectomy (PD) for curative treatment whereas benign AT can be appropriat ely treated by local resection. This study evaluated the accuracy of e ndoscopic exploration combining side-viewing duodenoscopy (SVD) with f orceps biopsies, endoscopic sphincterotomy (ES), and endoscopic ultras onography (EUS) to distinguish benign AT from malignant one, PATIENTS AND METHODS: Twenty-six patients with AT had preoperative SVD with for ceps biopsies, including 9 with ES, and EUS. Nodal status was evaluate d by EUS in all patients, but could not evaluate parietal spread in 6 in whom ES was previously done, Results of endoscopic examination were compared with pathologic examination after resection (2 local excisio ns for 2 benign AT, and 24 PD for 20 malignant and 4 benign AT). RESUL TS: Accuracy of histologic examination of the 26 biopsies of the papil la was 69%, After ES, accuracy of intra-ampullary biopsies was 77%. Th e EUS had a 75% accuracy for the parietal spread (tumor limited to amp ulla or not) and a 69% accuracy for the nodal status, In 11 patients, all explorations were consistent with a benign lesion, but 6 of these patients had a histologically proven malignancy, including one with no dal metastases and two with duodenal involvement, CONCLUSIONS: Side-vi ewing duodenoscopy with biopsies, even after ES, combined with EUS is not accurate enough to preoperatively ensure that an AT is benign, Ind ication for a local resection based on these explorations alone is not safe. (C) 1997 by Excerpta Medica, Inc.