Biopsies of the ampullary region in patients suspected to have sphincter of Oddi dysfunction

Tumors of the ampulla of Vater that develop within the ampulla can go unrecognized during endoscopic examination. Patients with intra-ampullary tumors may present with a clinical picture very similar to that of sphincter of Oddi dysfunction. We wished to determine what percentage of patients initial...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 1995-10, Vol.42 (4), p.296-300
Main Authors: Ponchon, Thierry, Aucia, Nestor, Mitchell, Richard, Chavaillon, Annick, Bory, Roger, Hedelius, Franck
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnosis
Adult
Aged
Aged, 80 and over
Ampulla of Vater - pathology
Biological and medical sciences
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct Diseases - diagnosis
Common Bile Duct Diseases - surgery
Common Bile Duct Neoplasms - diagnosis
Diagnosis, Differential
Diagnostic Errors
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Sphincter of Oddi - surgery
Sphincterotomy, Endoscopic
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Summary:Tumors of the ampulla of Vater that develop within the ampulla can go unrecognized during endoscopic examination. Patients with intra-ampullary tumors may present with a clinical picture very similar to that of sphincter of Oddi dysfunction. We wished to determine what percentage of patients initially diagnosed with sphincter of Oddi dysfunction are later found to have an intra-ampullary neoplasm. Sixty-nine consecutive patients were considered to have sphincter of Oddi dysfunction and subsequently were treated with endoscopic sphincterotomy. No gallstones were found in the gallbladder or bile duct. Patients returned for biopsies of the ampulla at least 10 days after the endoscopic sphincterotomy. Three patients (4.3%) were found to have ampullary adenocarcinoma. Thirty-six had normal results of biopsy analysis and 30 had inflammatory or fibrotic changes on biopsy specimens. No objective criteria (clinical, biologic, endoscopic, or radiographic) that would help to distinguish between an ampullary tumor and sphincter of Oddi dysfunction were identified. Biopsies of the ampulla should be performed in all patients suspected of having sphincter of Oddi dysfunction and treated by endoscopic sphincterotomy. (Gastrointest Endosc 1995;42:296-300.)
ISSN:0016-5107
1097-6779
DOI:10.1016/S0016-5107(95)70125-7