Tumours in the region of the papilla of Vater. Diagnosis via endoscopy, biopsy, brush cytology, ERPC and CT-scan.

Thirty-two cases of tumour in the region of papilla of Vater are reported including five benign lesions (papillitis, polyp, duodenitis) and 27 periampullary carcinomas. Duodenoscopy has a key position in the diagnosis of these lesions, since by judging the endoscopic appearance of the papilla a forceps biopsy and brush cytology can be performed. Accuracy of forceps biopsy is up to 66%, whereas diagnostic accuracy of brush cytology only reaches about 44%. Because of the possible false positive results, brush cytology should be regarded with reserve in the diagnosis of periampullary carcinomas. Retrograde filling of contrast medium of bile and/or pancreatic ducts mainly serves for delineation of tumour size and allows fine needle aspiration under fluoroscopy. Success rate of retrograde cannulation is rather low. CT-scans are of great importance in detecting metastases of liver and/or regional lymphnodes but are of little value in diagnosing the primary lesion.