Adenoma of the papilla of Vater: a possible role for intraductal ultrasound (IDUS).

Like in adenomas of the colon, an adenoma-carcinoma sequence is expected from adenomatous growths in the papilla of Vater. Papilloadenomas must therefore be resected. Imaging techniques have a decisive influence on the choice of operative technique and consequently on perioperative mortality. Using conventional endoscopic ultrasonography, detection of lesions smaller than 10 mm in diameter is rare. The probes available up to now for intraductal sonography with an external diameter of between 3.4 and 12 mm were too rigid and could be inserted transpapillarily in only a few cases. The recent development, however, of high-frequency, extremely flexible ultrasound catheters with an external diameter of 1.17 mm makes intraductal examination of the pancreatic ductal system possible. We present a case of a 66 year-old female patient, in whom, for the first time, a histologically adenomatous lesion of the papilla of Vater could be examined with intraductal sonography using the endoscopic retrograde, transpapillary approach. As there was no evidence of infiltrative growth, the patient underwent a modified duodenum-preserving resection of the pancreatic head. Histological examination of the resected specimen confirmed the preoperative intraductal sonography findings. Since conventional endosonography did not detect the lesion in this case, intraductal sonography with flexible, high-frequency catheters as presented here, clearly may have a role in extending the possibilities of preoperative examination, especially of focal lesions in the periampullary region.