Tumours of Vater’s ampulla – occurrence, symptoms, diagnosis and endoscopic treatment

Introduction: Tumours of Vater’s ampulla are very rare and may occur as inflammatory or neoplastic tumours – adenomas or more frequent adenocarcinomas. Duodenoscopy allows direct visualization of Vater’s ampulla tumours and permits biopsy for histological assessment. Endoscopic retrograde cholangiopancreatography (ERCP) enables biliary stents to be inserted for palliative tumour treatment. The use of endo-scopic methods in the treatment of Vater’s ampulla adenomas is recently considered.

Aim: The aim of this study was to evaluate the frequency
of occurrence, symptoms, detectability and treatment of tu-mours of Vater’s ampulla, mainly the clinical efficacy of endos-copic procedures.

Material and methods: A retrospective analysis of 1134 ERCP and duodenoscopies performed in the Department of Dige-stive Tract Diseases, Medical University of Lodz from 2003 to 2007 was made. Tumour of Vater’s ampulla was revealed in
31 cases (2.7%). In all patients age, sex, clinical symptoms, laboratory findings, imaging methods and histological results were analyzed.

Results: Among 31 analyzed patients with tumour of Vater’s ampulla we have finally diagnosed: in 13 patients (42%) adenocarcinoma of Vater’s papilla, in 9 patients (29%) adenoma, in 3 (9.7%) inflammatory tumour due to chronic pancreatitis, pancreatic cancer in 2 patients (6.5%) and in 2 (6.5%) cholangiocarcinoma. Thirteen patients (42%) were qualified for surgical treatment and 11 (35.5%) were treated with endoscopic stenting. Endoscopic resection of adenoma of Vater’s ampulla, with diathermy snare, was performed in two patients. Observation of these patients has lasted 18 and 24 months. In one patient resection of the adenoma was complete.

Conclusions: Frequency of tumours of Vater’s ampulla diagnosed by ERCP is high. The role of endoscopic methods in the diagnosis and treatment of tumours of Vater’s ampulla is significant and includes palliative biliary stenting and radical adenoma resection.