Clinical and endoscopic aspects of tumors of the ampulla of Vater.

Diverse tumors may arise at the ampulla of Vater, although the clinical manifestations for all types of lesions are similar. Carcinoma and benign adenomas are the most important ampullary tumors, and there is evidence that adenomas are premalignant. Endoscopy offers the best prospect of accurate diagnosis, but the sensitivity and specificity of this diagnostic modality is less than expected. In particular, endoscopic biopsies may be falsely negative for carcinoma in a significant percentage of cases. When successful, ERCP may demonstrate dilated pancreatic and bile ducts and in some cases the presence of a tumor mass. The preferred treatment for virtually all ampullary tumors is surgery, the general types of operation being local resection, pancreatoduodenectomy, and biliary decompression procedures. The choice of operation depends on whether the tumor is benign or malignant, its extent, especially if malignant, and an assessment of the patient's ability to withstand radical resection. Although the operative morbidity and mortality is lower for local excision in comparison to pancreatoduodenectomy, there is a greater chance for recurrence of malignant and premalignant neoplasms when the tumor is locally excised.