No abstract available.
Ampulla of Vater* ; Duodenum ; Tuberculosis*

BACKGROUND/AIMS: Cannulation failure to biliary tract has been reported in 10% of patients who are performed diagnostic and therapeutic ERCP. Infundibulotomy by use of needle knife is cutting a bulbar part of protruding papilla, which has merit to avoid complete destruction of sphincter of Oddi and serious side effects than general precutting method. We want to know effectiveness and safety of infundibulotomy. METHODS: From January 1997 to December 1998, 36 patients who failed cannulation over three times trial by conventional method are included to this study. We compared the success rate of cannulation and procedure related complication according to bile duct dilatation, periampullary diverticulum and shape of ampulla of Vater. RESULTS: 1) Success rate of cannulation to bile duct is 81% (29/36). 2) All patients in group of bile duct dilatation (14) are succeed to cannulation, which is significantly high compare to other group (p=0.0288). 3) There was no statistical difference in success rate according to presence of periampullary diverticulum. 4) In groups of bulging prominent papilla are succeed in 23 among 26 patients, which is tendency of high in patients than other group (p=0.0760). 5) Total occurrence of procedure related complication was 33% (12/36). 6) The complication rate was not different in two groups according to cannulation success 7) The complication rate was tendency of high in patients without bile duct dilatation (p=0.0756). CONCLUSIONS: Infundibulotomy by use of needle knife is effeetive and safe cannulation method to patient who failed cannulation to bile duct. Success of cannulation is low and occurrence of complication is tendency of high in patient without bile duct dilation, which propose endoscopists attention in selection of indications.
Ampulla of Vater ; Bile Ducts ; Biliary Tract ; Catheterization* ; Cholangiopancreatography, Endoscopic Retrograde* ; Dilatation ; Diverticulum ; Humans ; Needles ; Sphincter of Oddi

Recently, the capability cannulating the ampulla of Vater through the endoscope makes it possible introduce the recording ctheter deeply into the common bile and main pancreatic duct. Using these techniques, several authors have measured intraductal pressures in controls and in patients with various biliary and pancreatic diseases. Csendes et al. (continue...)
Ampulla of Vater ; Bile ; Endoscopes ; Humans ; Manometry* ; Pancreatic Diseases ; Pancreatic Ducts ; Sphincter of Oddi*

Most tumors affecting Vater's ampulla are adenocarcinomas, but a neuroendocrine carcinoma in the ampulla of Vater is extremely rare. The coexistence of these two tumors has been reported in only a few cases. Here, we report a rare case of a collision tumor of the ampulla of Vater with an adenocarcinoma and a large cell neuroendocrine carcinoma.
Adenocarcinoma ; Ampulla of Vater ; Carcinoma, Neuroendocrine

Study on 4 cases of malignant tumor of Vater’s ampulla operated at Viet-Duc Hospital and 1 case treated at University of Medicine and Pharmacy at Ho Chi Minh City between August 2003 and December 2004. Results: clinical sign is biliary obstruction jaundice. Gastroduodenoscopy with flexible tube found that papilla of Vater with the diameter lower than 3cm (histological finding: carcinomas), without metastasis to adjacent duodenum. Tumor invasion into head of pancreas and the lower of choledochous duct was determined by pancreatic and liver ultrasound, CT scanner or MRI examinations, in combination with intraoperative balance, immediate biopsy of lymph nodes in group 14 and group 8, sections of bile duct, pancreatic duct and duodenum in order to ensure the elimination of surgery. Initial outcomes showed that there wasn’t post-operative complication or death.
Ampulla of Vater ; Duodenum ; Therapeutics ; Surgery

Duodenal duplication cysts are rare congenital malformations. Most symptomatic cases are diagnosed in children and usually present with obstructive findings or bleeding symptoms. Treatment traditionally involves surgical resection, which can be often difficult because of the close proximity of the cysts to the papilla and bilopancreatic confluence. Endoscopic therapy has been used as an alternative to open surgery in a few selected cases. We report a case with a duodenal duplication cyst containing a brown pigmented stone within the cystic lumen. He was visited because of sudden right upper quadrant abdominal pain. An abdominal computed tomography revealed the presence of a cyst with a stone, which was finally removed by endoscopic resection.
Abdominal Pain ; Ampulla of Vater ; Child ; Hemorrhage ; Humans

Small cell carcinoma in the ampulla of Vater is rare, and the concurrent occurrence of adenocarcinoma and small cell carcinoma is extremely rare. We report the case of a double primary tumor, adenocarcinoma and small cell carcinoma, in the ampulla of Vater.
Adenocarcinoma ; Ampulla of Vater ; Carcinoma, Small Cell

The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature.
Adenocarcinoma ; Adult ; Ampulla of Vater* ; Chemistry ; Choledochal Cyst ; Cholelithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct* ; Humans ; Pancreatic Ducts ; Pancreatitis* ; Sphincter of Oddi Dysfunction

Ampulla of Vater (AoV) is a small dilated duct less than 1.5 cm long, formed by the union of pancreatic duct and common bile duct. AoV has also anatomic layer of mucosa, sphincter of Oddi, perisphincteric or duodenal submucosa, and duodenal proper muscle, which corresponds to mucosa, muscularis mucosa, submucosa, and proper muscle layer of other gastrointestinal tract organs, respectively. Because of its small compact size and variation of anatomic structure, it is sometimes difficult to identify layering architecture of AoV. This anatomic difficulty may cause some problem in T classification of ampullary carcinoma (AC). The most confusing point in T classification is the vague definition of T2, "Tumor invades duodenal wall". It seems that duodenal wall includes duodenal mucosa, submucosa, and proper muscle layer. However there is no precise description or definition about duodenal wall that might lead personal variation in T classification of AC staging. We found that clinical course of AC with perisphincteric and/or duodenal submucosal invasion is more close to AC with T2 than T1. Although it is described as T1b according to T classification scheme of ordinary gastrointestinal tract cancer, we thought AC with T1b may have more high-grade malignant potential than those of other gastrointestinal (GI) tract malignancy. AC showed various clinicopatholgic findings that represent heterogeneous tumor groups within category of AC. Recently site-specific classification of AC was introduced, and it showed relatively well-categorized clinical prognosis. It may be reasonable to understand site-specific tumorigenesis in AC. The standard gross protocol is needed to evaluate pathologic T classification of AC. In conclusion, ampullary neoplasm is composed of various subtypes, which require a separate approach according to anatomic epicenter of ampullary neoplasm. Although submucosal invasion in AC was classified into pT1b, its' biologic behavior is more close to pT2.
Ampulla of Vater ; Carcinogenesis ; Classification ; Common Bile Duct ; Duodenum ; Gastrointestinal Neoplasms ; Gastrointestinal Tract ; Humans ; Mucous Membrane ; Neoplasm Staging ; Pancreatic Ducts ; Prognosis ; Sphincter of Oddi

Endoscopic retrograde cholangiopancreatography (ERCP) in post-gastrectomy patients with Billroth II (BII) reconstruction and Roux-en-Y (RY) reconstruction presents a challenge to therapeutic endoscopists. Major difficulties, including intubation to the ampulla of Vater, selective cannulation, and ampullary intervention, must be overcome in these patients. Recent data have shown that device-assisted ERCP allows for high success rates in these patients because various devices are useful for overcoming major difficulties. Therefore, good knowledge of postoperative anatomy and various devices is mandatory before performing ERCP procedures for post-gastrectomy patients.
Ampulla of Vater ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Gastrectomy* ; Gastroenterostomy ; Humans ; Intubation