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Naoki Okano,Yoshinori Igarashi,Seiichi Hara,Kensuke Takuma,Itaru Kamata,Yui Kishimoto,Takahiko Mimura,Ken Ito,Yasukiyo Sumino 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2
Background/Aims: In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. Thisprocedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopicultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy. Methods: The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy)who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographicevaluation and pathological diagnosis of these tumors. Results: The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors,and 50% for pT3–4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomasand pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3–4 tumors, for an overall accuracy of 80% for T-staging. Conclusions: EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniquesare not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequatefor treating adenomas and pTis tumors.