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Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas

Show simple item record Azih L.C. Broussard B.L. Phadnis M.A. Heslin M.J. Eloubeidi M.A. Varadarajulu S. Arnoletti J.P.
dc.contributor.editor 2013 2017-10-05T15:38:17Z 2017-10-05T15:38:17Z 2013
dc.identifier 10.3748/wjg.v19.i4.511
dc.identifier.issn 10079327
dc.description.abstract AIM: To investigate endoscopic ultrasound (EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection. METHODS: Records of 111 patients seen at our institution from November 1999 to July 2011 with the postoperative pathological diagnosis of benign ampullary and duodenal adenomas were reviewed. Records of patients who underwent preoperative EUS for diagnostic purposes were identified. The accuracy of EUS in predicting the absence of muscular invasion was assessed by comparing EUS reports to the final surgical pathological results. In addition, the incidence of the post-operative complications over a period of 30 d and the subsequent long-term outcome (recurrence) over a period of 30 mo associated with endoscopic and transduodenal surgical resection was recorded, compared and analyzed. RESULTS: Among 111 patients with benign ampullary and duodenal adenomas, 47 underwent preoperative EUS for 29 peri-ampullary lesions and 18 duodenal lesions. In addition, computed tomography was performed in 18 patients, endoscopic retrograde cholangio-pancreatography in 10 patients and esophagogastroduodenoscopy in 22 patients. There were 43 patients with sporadic adenomas and 4 patients with familial adenomatous polyposis (FAP)-other polyposis syndromes. In 38 (81percent, P 0.05) patients, EUS reliably identified absence of submucosal and muscularis invasion. In 4 cases, EUS underestimated submucosal invasion that was proven by pathology. In the other 5 patients, EUS predicted muscularis invasion which could not be demonstrated in the resected specimen. EUS predicted tumor muscularis invasion with a specificity of 88percent and negative predictive value of 90percent (P 0.05). Types of resection performed included endoscopic resection in 22 cases, partial duodenectomy in 9 cases, transduodenal ampullectomy with sphincteroplasty in 10 cases and pancreaticoduodenectomy in 6 cases. The main post-operative final pathological results included villous adenoma (n = 5), adenoma (n = 8), tubulovillous adenoma (n = 10), tubular adenoma (n = 20) and hyperplastic polyp (n = 2). Among the 47 patients who underwent resection, 8 (17percent, 5 of which corresponded to surgical resection) developed post-procedural complications which included retroperitoneal hematoma, intra-abdominal abscess, wound infection, delayed gastric emptying and prolonged ileus. After median followup of 20 mo there were 6 local recurrences (13percent, median follow-up = 20 mo) 4 of which were in patients with FAP. CONCLUSION: EUS accurately predicts the depth of mucosal invasion in suspected benign ampullary and duodenal adenomas. These patients can safely undergo endoscopic or local resection. © 2013 Baishideng. All rights reserved.
dc.format.extent Pages: (511-515)
dc.language English
dc.publisher WANCHAI
dc.relation.ispartof Publication Name: World Journal of Gastroenterology; Publication Year: 2013; Volume: 19; no. 4; Pages: (511-515);
dc.source Scopus
dc.title Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas
dc.type Article
dc.contributor.affiliation Azih, L.C., Department of General Surgery, University of Alabama Birmingham, Birmingham, AL 35233, United States
dc.contributor.affiliation Broussard, B.L., Department of General Surgery, University of Alabama Birmingham, Birmingham, AL 35233, United States
dc.contributor.affiliation Phadnis, M.A., Department of Biostatistics, Kansas University Medical Center, Kansas City, KS 66160, United States
dc.contributor.affiliation Heslin, M.J., Department of Surgical Oncology, University of Alabama Birmingham, Birmingham, AL 35233, United States
dc.contributor.affiliation Eloubeidi, M.A., Department of Gastroenterology, American University of Beirut, Beirut 1107 2020, Lebanon
dc.contributor.affiliation Varadarajulu, S., Department of Gastroenterology, The Center for Specialized Surgery at Florida Hospital, Orlando, FL 32804, United States
dc.contributor.affiliation Arnoletti, J.P., Department of Surgical Oncology, The Center for Specialized Surgery at Florida Hospital, Orlando, FL 32804, United States
dc.contributor.authorAddress Azih, L. C.; Department of General Surgery, University of Alabama Birmingham, 1922 3rd Avenue South KB 217, Birmingham, AL 35233, United States; email:
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine; Division: Gastroenterology and Hepatology;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision Gastroenterology and Hepatology
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Azih, LC
dc.contributor.authorInitials Broussard, BL
dc.contributor.authorInitials Phadnis, MA
dc.contributor.authorInitials Heslin, MJ
dc.contributor.authorInitials Eloubeidi, MA
dc.contributor.authorInitials Varadarajulu, S
dc.contributor.authorInitials Arnoletti, JP
dc.contributor.authorReprintAddress Azih, LC (reprint author), Univ Alabama Birmingham, Dept Gen Surg, 1922 3rd Ave S KB 217, Birmingham, AL 35233 USA.
dc.contributor.authorUniversity American University of Beirut Medical Center
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dc.description.citedCount 2
dc.description.citedTotWOSCount 3
dc.description.citedWOSCount 3
dc.format.extentCount 5
dc.identifier.coden WJGAF
dc.identifier.pubmedID 23382629
dc.identifier.scopusID 84873696156
dc.publisher.address ROOM 1701, 17-F, HENAN BUILDING, NO. 90, JAFFE RD, WANCHAI, HONG KONG 100025, PEOPLES R CHINA
dc.relation.ispartOfISOAbbr World J. Gastroenterol.
dc.relation.ispartOfIssue 4
dc.relation.ispartofPubTitle World Journal of Gastroenterology
dc.relation.ispartofPubTitleAbbr World J. Gastroenterol.
dc.relation.ispartOfVolume 19
dc.source.ID WOS:000314211200009
dc.type.publication Journal
dc.subject.otherAuthKeyword Cholangio-pancreatography
dc.subject.otherAuthKeyword Duodenal periampullary adenoma
dc.subject.otherAuthKeyword Endoscopic ultrasound
dc.subject.otherAuthKeyword Esophagogastroduodenoscopy
dc.subject.otherIndex abdominal abscess
dc.subject.otherIndex adenoma
dc.subject.otherIndex adult
dc.subject.otherIndex aged
dc.subject.otherIndex ampullary adenoma
dc.subject.otherIndex article
dc.subject.otherIndex computer assisted tomography
dc.subject.otherIndex diagnostic accuracy
dc.subject.otherIndex duodenum tumor
dc.subject.otherIndex endoscopic echography
dc.subject.otherIndex endoscopic retrograde cholangiopancreatography
dc.subject.otherIndex esophagogastroduodenoscopy
dc.subject.otherIndex female
dc.subject.otherIndex follow up
dc.subject.otherIndex human
dc.subject.otherIndex ileus
dc.subject.otherIndex major clinical study
dc.subject.otherIndex male
dc.subject.otherIndex mucosa
dc.subject.otherIndex outcome assessment
dc.subject.otherIndex retroperitoneal hematoma
dc.subject.otherIndex retrospective study
dc.subject.otherIndex sensitivity and specificity
dc.subject.otherIndex stomach function disorder
dc.subject.otherIndex wound infection
dc.subject.otherIndex Cholangio-pancreatography
dc.subject.otherIndex Duodenal periampullary adenoma
dc.subject.otherIndex Endoscopic ultrasound
dc.subject.otherIndex Esophagogastroduodenoscopy
dc.subject.otherIndex Adenoma
dc.subject.otherIndex Adult
dc.subject.otherIndex Aged
dc.subject.otherIndex Aged, 80 and over
dc.subject.otherIndex Ampulla of Vater
dc.subject.otherIndex Cholangiopancreatography, Endoscopic Retrograde
dc.subject.otherIndex Common Bile Duct Neoplasms
dc.subject.otherIndex Duodenal Neoplasms
dc.subject.otherIndex Endoscopy, Digestive System
dc.subject.otherIndex Endosonography
dc.subject.otherIndex Female
dc.subject.otherIndex Humans
dc.subject.otherIndex Intestinal Mucosa
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Neoplasm Invasiveness
dc.subject.otherIndex Patient Selection
dc.subject.otherIndex Postoperative Complications
dc.subject.otherIndex Predictive Value of Tests
dc.subject.otherIndex Retrospective Studies
dc.subject.otherIndex Time Factors
dc.subject.otherIndex Tomography, X-Ray Computed
dc.subject.otherIndex Treatment Outcome
dc.subject.otherKeywordPlus LOCAL RESECTION
dc.subject.otherKeywordPlus VILLOUS TUMORS
dc.subject.otherKeywordPlus TRANSDUODENAL EXCISION
dc.subject.otherKeywordPlus PERIAMPULLARY TUMORS
dc.subject.otherKeywordPlus COMPUTED-TOMOGRAPHY
dc.subject.otherKeywordPlus VATER
dc.subject.otherKeywordPlus PAPILLA
dc.subject.otherKeywordPlus ULTRASONOGRAPHY
dc.subject.otherKeywordPlus CARCINOMA
dc.subject.otherKeywordPlus DIAGNOSIS
dc.subject.otherWOS Gastroenterology and Hepatology

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