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New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system

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Abstract

Background

A newly developed narrow-band imaging (NBI) system, which uses modified optical filters, can yield clear images of microvessels and surface structure in gastric and colonic diseases. In the present study, we investigated the ability of magnifying endoscopy with NBI (MENBI) to diagnose and differentiate between benign and malignant ampullary tumors.

Methods

Fourteen patients, whose ampullas were noted to be significantly enlarged or protruding with conventional endoscopy, were enrolled in the study. Specimens, which were obtained by forceps biopsy, endoscopic papillectomy, and/or surgery, were retrieved for histopathological examination. The correlation between MENBI images and histopathological findings was investigated. MENBI findings were classified as I, oval-shaped villi; II, pinecone/leaf-shaped villi; or III, irregular/nonstructured. In addition, tortuous, dilated, and network-like vessels noted on the ampullary lesions with MENBI were defined as abnormal vessels.

Results

In 6 of 14 patients, the ampullary changes were proven to be inflammatory in forceps biopsy specimens, without any evidence of malignancy after more than 1 year of follow-up. In five patients, ampullary lesions were treated by endoscopic papillectomy, and in three, by pancreatoduodenectomy. All adenomas and adenocarcinomas had type II and/or type III surface structures, and patients whose ampulla had a type I surface structure had only inflammatory or hyperplastic changes. In addition, abnormal vessels were seen only in adenocarcinomas and never in adenomas.

Conclusions

MENBI has the ability and potential to predict histological characteristics of ampullary lesions.

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Authors and Affiliations

  1. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Yujiro Uchiyama, Hiroo Imazu, Hiroshi Kakutani, Shoryoku Hino, Kazuki Sumiyama, Akira Kuramochi, Shintaro Tsukinaga, Kazuhiro Matsunaga, Takashi Nakayoshi, Ken-ichi Goda, Shoichi Saito, Mitsuru Kaise & Muneo Kawamuara

  2. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Salem Omar

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Hisao Tajiri

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  1. Yujiro Uchiyama
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  15. Hisao Tajiri
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Uchiyama, Y., Imazu, H., Kakutani, H. et al. New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system. J Gastroenterol 41, 483–490 (2006). https://doi.org/10.1007/s00535-006-1800-7

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  • DOI: https://doi.org/10.1007/s00535-006-1800-7

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