Diagnosis of ampullary cancer.

Endoscopic papillectomy has been reported to be the treatment of choice in patients with ampullary adenoma. For ampullary cancer, pancreaticoduodenectomy is the standard treatment. Since neither lymphatic permeation, vascular invasion, nor lymph node metastasis is observed in patients with ampullary cancer limited to the mucosa, endoscopic resection of such tumors can be justified if no ductal infiltration into the bile or pancreatic duct is documented. For its application, accurate preoperative staging is mandatory. Transpapillary intraductal ultrasonography can provide useful information for making therapeutic decisions, especially in the selection of patients for endoscopic papillectomy.