Performance characteristics of EUS for locoregional evaluation of ampullary lesions.
Gastrointest Endosc
; 81(2): 380-8, 2015 Feb.
Article
in En
| MEDLINE
| ID: mdl-25293823
ABSTRACT
BACKGROUND:
The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear.OBJECTIVES:
To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions.DESIGN:
Retrospective cohort study.SETTING:
Tertiary-care referral center. PATIENTS All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. INTERVENTION EUS. MAIN OUTCOME MEASUREMENTS Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy.RESULTS:
We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively.LIMITATION:
Retrospective design.CONCLUSIONS:
EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ampulla of Vater
/
Adenocarcinoma
/
Adenoma
/
Common Bile Duct Neoplasms
/
Endosonography
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Gastrointest Endosc
Year:
2015
Document type:
Article
Affiliation country:
Thailand