Abstract
From a large series of patients referred for endoscopic retrograde cholangiopancreatography to one endoscopist, 49 patients had the duodenoscopic appearance of a periampullary tumour. Thirty eight of these lesions were neoplastic, but the remaining 11 patients had inflammatory non-neoplastic lesions (pseudotumours). These could not be distinguished from the neoplasms on endoscopic appearances. The cholangiopancreatograms were similar except that the diameter of the pancreatic duct tended to be higher in the tumour group and gall stones were present significantly more often in the patients with pseudotumour. Endoscopic biopsy correctly diagnosed 28 of 34 ampullary carcinomas. Two of the 11 pseudotumour patients were subjected to surgical excision biopsy because of suspicious histological features of endoscopic biopsy. In the neoplastic group 19 patients underwent Whipple's procedure, seven surgical bypass, seven endoscopic sphincterotomy only and five died without successful biliary drainage. The overall one year survival was 44.7%. By contrast, the patients with pseudotumours were clinically well at a median follow up 24 months (range 12-41 months), after endoscopic sphincterotomy except for one 89 year old patient who died 22 months later from unrelated causes.
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- Blumgart L. H., Kennedy A. Carcinoma of the ampulla of Vater and duodenum. Br J Surg. 1973 Jan;60(1):33–40. doi: 10.1002/bjs.1800600109. [DOI] [PubMed] [Google Scholar]
- Bourgeois N., Dunham F., Verhest A., Cremer M. Endoscopic biopsies of the papilla of Vater at the time of endoscopic sphincterotomy: difficulties in interpretation. Gastrointest Endosc. 1984 Jun;30(3):163–166. doi: 10.1016/s0016-5107(84)72357-1. [DOI] [PubMed] [Google Scholar]
- Cooperman A. M. Cancer of the ampulla of vater, bile duct, and duodenum. Surg Clin North Am. 1981 Feb;61(1):99–106. doi: 10.1016/s0039-6109(16)42335-2. [DOI] [PubMed] [Google Scholar]
- Coutsoftides T., Macdonald J., Shibata H. R. Carcinoma of the pancreas and periampullary region: a 41 year experience. Ann Surg. 1977 Dec;186(6):730–733. doi: 10.1097/00000658-197712000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Curry B., Gray N. Visceral neurofibromatosis. An unusual cause of obstructive jaundice. Br J Surg. 1972 Jun;59(6):494–496. doi: 10.1002/bjs.1800590624. [DOI] [PubMed] [Google Scholar]
- Denjoy R. Les tumeurs bénignes de la papille de Vater. J Chir (Paris) 1968 Feb;95(2):211–226. [PubMed] [Google Scholar]
- Forrest J. F., Longmire W. P., Jr Carcinoma of the pancreas and periampullary region. Ann Surg. 1979 Feb;189(2):129–138. doi: 10.1097/00000658-197902000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gouerou H., Mendez J., Crespon B., Berman H., Housset P., Debray C. La duodénoscopie dans le diagnostic des ampullomes vatériens (23 cas) Arch Fr Mal App Dig. 1976 Dec;65(8):569–575. [PubMed] [Google Scholar]
- Levin D. L., Connelly R. R., Devesa S. S. Demographic characteristics of cancer of the pancreas: mortality, incidence, and survival. Cancer. 1981 Mar 15;47(6 Suppl):1456–1468. doi: 10.1002/1097-0142(19810315)47:6+<1456::aid-cncr2820471404>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
- MILLER E. M., DOCKERTY M. B., WOLLAEGER E. E., WAUGH J. M. Carcinoma in the region of the papilla of Vater; a study of cases in which resection was performed. Surg Gynecol Obstet. 1951 Feb;92(2):172–182. [PubMed] [Google Scholar]
- Obertop H., Bruining H. A., Schattenkerk M. E., Eggink W. F., Jeekel J., Van Houten H. Operative approach to cancer of the head of the pancreas and the peri-ampullary region. Br J Surg. 1982 Oct;69(10):573–576. doi: 10.1002/bjs.1800691005. [DOI] [PubMed] [Google Scholar]
- Schlippert W., Lucke D., Anuras S., Christensen J. Carcinoma of the papilla of Vater. A review of fifty-seven cases. Am J Surg. 1978 Jun;135(6):763–770. doi: 10.1016/0002-9610(78)90160-5. [DOI] [PubMed] [Google Scholar]
- Schulten M. F., Oyasu R., Beal J. M. Villous adenoma of the duodenum. A case report and review of the literature. Am J Surg. 1976 Jul;132(1):90–96. doi: 10.1016/0002-9610(76)90297-x. [DOI] [PubMed] [Google Scholar]
- Smith R. The surgeon and the patient with cancer. J R Coll Surg Edinb. 1970 Mar;15(2):63–76. [PubMed] [Google Scholar]
- Sobol S., Cooperman A. M. Villous adenoma of the ampulla of Vater. An unusual cause of biliary colic and obstructive jaundice. Gastroenterology. 1978 Jul;75(1):107–109. [PubMed] [Google Scholar]
- Walsh D. B., Eckhauser F. E., Cronenwett J. L., Turcotte J. G., Lindenauer S. M. Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment. Ann Surg. 1982 Feb;195(2):152–157. doi: 10.1097/00000658-198202000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Warren K. W., Choe D. S., Plaza J., Relihan M. Results of radical resection for periampullary cancer. Ann Surg. 1975 May;181(5):534–540. doi: 10.1097/00000658-197505000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wise L., Pizzimbono C., Dehner L. P. Periampullary cancer. A clinicopathologic study of sixty-two patients. Am J Surg. 1976 Feb;131(2):141–148. doi: 10.1016/0002-9610(76)90087-8. [DOI] [PubMed] [Google Scholar]


