Akademik Veri Yönetim Sistemi
Turkish Journal of Gastroenterology, cilt.8, sa.4, ss.406-412, 1997 (Scopus)
Objectives: Although periampullary carcinoma usually can be diagnosed at an early stage because of its strategic location, in a substantial number of cases (23% to 25% of cases of periampullary carcinoma), the papilla can be prominent, but without an identifiable mass or ulceration. As a result, duodenoscopy alone fail to identify the tumor. In this series, the usefulness of sphincterotomy in establishing a diagnosis of periampullary carcinoma is documented. Materials and Methods: A total of 664 patients, who had clinical, biochemical and/or sonographic evidence of pancreaticobiliary disorders underwent endoscopic retrograde cholangiopancreaticography (ERCP) at Hacettepe University Hospital between March 1985 and September 1994 were studied. All identified lesions were biopsied. Result: In 66 of the 664 patients, a specific periampullary or pancreatic diagnosis could be made. These included 30 cases of pancreatic carcinoma (14 in the head, 15 in the corpus, and one in the tail), 10 cases of chronic pancreatitis, 15 cases of periampullary carcinoma and 11 miscellaneous. None of the 15 periampullary carcinomas was demonstrable by abdominal computed tomography, sonography or pancreatic angiography. In 12, the diagnosis was established immediately by endoscopic visualization of the tumor and biopsy. In the remaining three, the tumor was visualized as a protrutring mass only after papillatomy was performed. All cases were treated surgically with a pylorus preserving pancreaticoduodenectomy. No symptoms of dumping were experienced postoperatively. The survival of these 15 patients was good with a mean survival of 24.2 months. Conclusions: Careful endoscopic examination of the periampullary mucosa before and after sphincterotomy is required to identify periampullary carcinoma; a pylorus preserving pancreaticoduodenectomy revealed excellent post-surgical outcome with no post operative symptoms of the dumping syndrome.