Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Department of Gastroenterology, Hugh Chatham Memorial Hospital, Elkin, North Carolina, USA.
Endosc Ultrasound. 2016 May-Jun;5(3):184-8. doi: 10.4103/2303-9027.183978.
The management of ampullary lesions has evolved to include endoscopic ampullectomy (EA) as a curative approach to cancers of the ampulla of Vater. With this change comes a need to risk-stratify patients at initial diagnosis.
Patients with verified ampullary lesions (N = 50) were analyzed in a case-control design. We evaluated endoscopic ultrasound (EUS) data to define characteristics that yield a high sensitivity in selecting candidates for EA.
Using data from previously published studies yielded a sensitivity of 0.765 in appropriately identifying the 34 surgical cases. Expanding these characteristics increased the sensitivity of EUS to 0.971 in identifying surgical candidates. Additionally, of advanced disease cases, the expanded characteristics correctly identified these cases with a sensitivity of 1.0-improved over 0.708 using prior published data.
EA should be strongly considered if ampullary lesions are found to fit the following characteristics after EUS evaluation: lesion size <2.5 cm, invasion ≤4 mm, pancreatic duct dilatation ≤3 mm, ≤T1 lesion, no lymph nodes present, and no ductal stent in place. Furthermore, EUS data can be used to identify all high-risk lesions. With these characteristics identified, clinicians are better able to risk-stratify patients using EUS as either appropriate for or too high-risk for endoscopic resection.
壶腹区病变的治疗策略已演变为包括内镜下壶腹肿瘤切除术（EA），作为治疗 Vater 壶腹癌的一种方法。随着这种变化，需要在初始诊断时对患者进行风险分层。
采用病例对照设计对 50 例经证实的壶腹病变患者进行分析。我们评估了内镜超声（EUS）数据，以确定在选择 EA 候选者时具有高灵敏度的特征。
使用来自先前发表的研究的数据，EUS 在正确识别 34 例手术病例方面的灵敏度为 0.765。扩展这些特征可将 EUS 识别手术候选者的灵敏度提高至 0.971。此外，在晚期疾病病例中，扩展特征可正确识别这些病例，其灵敏度为 1.0，优于使用先前发表的数据的 0.708。
如果在 EUS 评估后发现壶腹病变符合以下特征，应强烈考虑进行 EA：病变大小<2.5cm，侵袭性≤4mm，胰管扩张≤3mm，≤T1 病变，无淋巴结转移，且无胆管支架。此外，EUS 数据可用于识别所有高危病变。有了这些特征，临床医生可以更好地使用 EUS 对患者进行风险分层，确定是否适合内镜下切除或风险过高。
