Indications for local excision of ampullary lesions associated with familial adenomatous polyposis.

BACKGROUND

The relative risk of periampullary carcinoma is high in patients with familial adenomatous polyposis (FAP). We examined the possibility of local treatment of the ampullary lesion of these patients in an early stage.

STUDY DESIGN

From August 1991 to April 1993, 37 patients with FAP underwent endoscopic examination and biopsy of the ampulla. Local excision of the ampulla was performed in seven patients.

RESULTS

Two of the seven patients were diagnosed with carcinoma in situ; the ages of the patients were 35 and 46 years. A 38-year-old woman had ampullary carcinoma infiltrating into the muscle of the sphincter of Oddi. These three cases showed a protruding change or deformity of the ampulla endoscopically. The laboratory data, cholangiogram, and abdominal ultrasonography were within normal limits. The superficial change of the ampulla along with the young age of the patients were considered to be factors that warranted further observation. Postoperative complications in two cases were treated successfully.

CONCLUSIONS

Indications for local excision of the ampulla of patients with FAP would be protruding change of the ampulla, biopsy showing adenoma with severe atypia or carcinoma, in situ, no jaundice with or without subclinical abnormality of laboratory data, no apparent dilatation in the bile duct, and age of more than 35 years.