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Dig Dis 2022 May 19. Epub 2022 May 19.

Background: Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of studies examining ampullary NEN makes it difficult to clarify their unique characteristics. This study aimed to elucidate the clinical characteristics of ampullary NEN. Read More

Eur Radiol 2022 May 19. Epub 2022 May 19.

Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul, 110-744, Republic of Korea.

Objectives: To construct a predictive nomogram for differentiating malignant from benign ampullary strictures using contrast-enhanced computed tomography (CT) findings combined with clinical findings.

Methods: In this retrospective study, 152 patients with ampullary stricture (98 benign and 54 malignant) who underwent contrast-enhanced CT were included. Various imaging findings of the ampulla, bile duct, main pancreatic duct, and periampullary area were evaluated and clinical findings including the presence of jaundice, carbohydrate antigen 19-9 level, and history of cholecystectomy were collected. Read More

Zhonghua Yi Xue Za Zhi 2022 May;102(18):1351-1358

Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.

The magnetic resonance imaging (MRI) features of intestinal-type periampullary carcinoma (IPAC) and pancreatobiliary-type periampullary carcinoma (PPAC) were compared and analyzed to discuss the optimal diagnosis scheme. Preoperative MRI images of 59 patients (32 males, 27 females, aged 37-80 years) diagnosed with periampullary carcinoma (PAC) confirmed by surgery and pathology in Nanjing Drum Tower Hospital from January 2017 to July 2020 were retrospectively analyzed. The patients were divided into 21 cases in the IPAC group (11 males, 10 females) and 38 cases in the PPAC group (21 males, 17 females) according to histopathological results. Read More

Urol Case Rep 2022 Jul 11;43:102080. Epub 2022 Apr 11.

Department of Urology, Iwate Medical University School of Medicine, 2-1-1, Yahaba, Shiwa-gun, Iwate, 028-3695, Japan.

We report a case of advanced renal pelvic cancer in a 69-year-old woman who presented with fatigue, appetite loss, and yellow sclera. Contrast-enhanced computed tomography revealed a large lesion mass extending from the right renal pelvis to the duodenum and surrounding enlarged lymph nodes. Gastroduodenal endoscopy revealed a mass in the ampulla of Vater, and an endoscopic biopsy was performed. Read More

Therap Adv Gastroenterol 2022 22;15:17562848221090820. Epub 2022 Apr 22.

Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), rue Gabrielle Perret-Gentil 4, 1211, Genève 1205, Switzerland.

Background: Endoscopic papillectomy is a minimally invasive treatment for benign tumors of the ampulla of Vater or early ampullary carcinoma. However, reported recurrence rates are significant and risk factors for recurrence are unclear.

Objective: The aims of this study were to evaluate the efficacy and safety of endoscopic papillectomy and to identify risk factors for recurrence and adverse events. Read More

Cancers (Basel) 2022 Mar 31;14(7). Epub 2022 Mar 31.

Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester M20 4BX, UK.

Perihilar cholangiocarcinoma (pCCA) is the anatomical sub-group of biliary tract cancer (BTC) arising between the second-order intrahepatic bile ducts and the cystic duct. Together with distal and intrahepatic cholangiocarcinoma (dCCA and iCCA; originating distal to, and proximal to this, respectively), gallbladder cancer (GBC) and ampulla of Vater carcinoma (AVC), these clinicopathologically and molecularly distinct entities comprise biliary tract cancer (BTC). Most pCCAs are unresectable at diagnosis, and for those with resectable disease, surgery is extensive, and recurrence is common. Read More

Zentralbl Chir 2022 Apr 4;147(2):160-167. Epub 2022 Apr 4.

Klinik und Poliklinik für Viszeral-, Thorax- u. Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland.

Ampullary carcinoma belongs to the cluster of periampullary cancers and is a rare, but increasing form of gastrointestinal malignancy. Due to the location of the tumour, occurrence of biliary obstruction is common. Symptoms due to the compression of the biliary tract facilitate early diagnosis, evoking a better prognosis. Read More

Front Surg 2022 18;9:833373. Epub 2022 Mar 18.

Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Objective: Tumor recurrence remains the main dilemma after surgical treatment of ampulla of Vater carcinoma. This study was designed to identify the prognostic factors and evaluate the recurrence patterns of ampulla of Vater cancer.

Methods: A total of 286 patients who underwent surgical resection of ampulla of Vater cancer in two medical centers from January 2000 to October 2016 were collected. Read More

Diagnostics (Basel) 2022 Feb 23;12(3). Epub 2022 Feb 23.

Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.

Although clear cell renal cell carcinoma (ccRCC) is easy to diagnose early and most can be radically resected, nearly one-third of patients still experience metastases after radical nephrectomy. The most common distant metastases sites of ccRCC are lung, bone and liver. However, periampullary metastasis of ccRCC is very rare and easy to misdiagnose. Read More

Surg Case Rep 2022 Mar 21;8(1):48. Epub 2022 Mar 21.

Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.

Background: Clostridium perfringens sepsis associated with massive intravascular hemolysis has an extremely poor prognosis. We here report a case of C. perfringens sepsis associated with massive intravascular hemolysis that developed secondary to a post-pancreaticoduodenectomy (PD) hepatic abscess. Read More

Gan To Kagaku Ryoho 2022 Feb;49(2):192-194

Dept. of Gastroenterological Surgery, Osaka General Medical Center.

A male in his twentieth was referred to our hospital for jaundice. Computed tomography(CT)showed dilation of the intrahepatic and extrahepatic bile ducts and showed a lesion at the ampulla of Vater, which caused obstructive jaundice. Upper gastrointestinal endoscopy revealed a tumor of protruded-predominant type with raised margins at the ampulla of Vater, and biopsy from the lesion indicated malignancy. Read More

In Vivo 2022 Mar-Apr;36(2):973-978

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

Background/aim: The optimal extent of lymph node dissection for ampullary carcinoma is controversial. The aim of this study was to investigate the efficacy of lymph node dissection for ampullary carcinoma.

Patients And Methods: Between 2000 and 2020, a total of 75 patients undergoing radical resection for ampullary carcinoma were included. Read More

Surg Case Rep 2022 Mar 2;8(1):38. Epub 2022 Mar 2.

Department of Gastroenterological Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

Background: Mixed neuroendocrine-non-neuroendocrine neoplasm (MINEN) is a rare disease and there is scarce literature on its diagnosis, treatment, and prognosis. We encountered two unusual cases of MINEN in the biliary tract, one in the ampulla of Vater and the other in the distal bile duct. In this report, we describe the clinical course of these two cases in detail. Read More

J Am Coll Surg 2022 01;234(1):48-53

From the Sidney Kimmel Medical College, Philadelphia, PA (Papai, CJ Yeo, Lavu).

Background: We hypothesized that pancreatic and periampullary adenocarcinoma recurrence after surgical resection may be affected by the shedding of malignant epithelial cells during surgical dissection and that this may have implications for disease recurrence and survival.

Study Design: In this ongoing, investigator-initiated prospective randomized controlled trial, patients with pancreatic and periampullary adenocarcinoma were randomized intraoperatively, postresection into 3 study arms: peritoneal lavage using 10 L normal saline or distilled water, or control group with no lavage. Peritoneal fluid was sampled for cytologic analysis (cytospin, cellblock, immunohistochemistry-Ber-EP4 antibody) at 4 stages: (1) abdominal entry pre-dissection, (2) resection bed after tumor extirpation, (3) ex vivo resected specimen, and (4) resection bed postlavage. Read More

BMC Gastroenterol 2022 Feb 6;22(1):51. Epub 2022 Feb 6.

Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu Province, China.

Background: Postoperative pancreatic fistula (POPF) is a frequent complication after pancreaticoduodenectomy (PD). This study aimed to investigate the impact of Vater's ampullary carcinoma (VAC) on clinically relevant POPF (CR-POPF) in patients undergoing PD.

Methods: Clinical data were gathered retrospectively from January 2018 to December 2020 for all patients undergoing PD. Read More

Clin J Gastroenterol 2022 Feb 3;15(1):205-209. Epub 2022 Feb 3.

Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-city, 700- 8511, Japan.

We report a rare case of neuroendocrine tumor of the ampulla of Vater in a 53-year-old Japanese male. The patient was admitted to our institution for workup of presyncope secondary to anemia. Medical history was pertinent for coronary artery disease, for which he had drug eluting stents (DES) placed and was on aspirin and clopidogrel therapy. Read More

Asian J Surg 2022 Mar 17;45(3):932-933. Epub 2022 Jan 17.

Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China. Electronic address:

J Surg Oncol 2022 Mar 11;125(4):642-645. Epub 2022 Jan 11.

Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.

Background: For patients with periampullary adenocarcinoma (PAC), pancreatoduodenectomy (PD) provides the best survival. Surgery on a subset of patients is aborted during PD. We analyzed these patients. Read More

Gastrointest Endosc 2022 05 4;95(5):896-904.e1. Epub 2022 Jan 4.

Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital-IRCCS, Milan, Italy.

Background And Aims: EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) has been proposed as an alternative procedure in patients with distal malignant biliary obstruction (DMBO) and failed ERCP.

Methods: This multicenter, retrospective analysis included all cases of EUS-CDS with LAMS performed in patients with DMBO and failed ERCP in 23 Italian centers from January 2016 to July 2020. Primary endpoints were technical and clinical success. Read More

Dig Endosc 2022 03 6;34(3):466-468. Epub 2022 Jan 6.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

Rev Gastroenterol Mex (Engl Ed) 2022 Jan-Mar;87(1):116-118. Epub 2021 Dec 27.

Departamento de Cirugía Hepatopancreatobiliar, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address:

Ann Surg Oncol 2022 Apr 20;29(4):2429-2440. Epub 2021 Dec 20.

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, Seoul, 03722, South Korea.

Background: Transduodenal ampullectomy (TDA) is performed for adenoma or early cancer of the ampulla of Vater (AoV). This study aimed to analyze the short- and long-term outcomes of TDA (TDA group) when compared with conventional pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PD group).

Methods: Patients who underwent TDA between January 2006 and December 2019, and PD cases performed for AoV malignancy with carcinoma in-situ (Tis) (high-grade dysplasia, HGD) and T1 and T2 stage from January 2010 to December 2019 were reviewed. Read More

Cureus 2021 Nov 12;13(11):e19492. Epub 2021 Nov 12.

Gastroenterology, Rafic Hariri University Hospital, Beirut, LBN.

Hypochloremia is an electrolyte disturbance characterized by low serum concentration of chloride ions, often occurring in acute illnesses and characterized by nonspecific signs and symptoms. It rarely results from decreased intake and is predominantly due to either renal or extra-renal losses. We report a case of severely worsening symptomatic hypochloremia resulting from an extra-renal loss of chloride ion in a 58-year-old female patient presenting for prolonged protracted vomiting. Read More

J Gastroenterol Hepatol 2022 Apr 5;37(4):669-677. Epub 2022 Jan 5.

Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea.

Background And Aim: Gallstones have been reported to be positively associated with hepatobiliary cancers. However, risks of these cancers by cholecystectomy or in patients with complicated gallstones are controversial. We studied the effect of cholecystectomy on the risk of cholangiocarcinoma (CCA) or hepatocellular carcinoma (HCC) in patients with gallstones and subgroup of complicated gallstones. Read More

Am J Surg Pathol 2022 Jun 15;46(6):754-764. Epub 2021 Dec 15.

Department of Pathology, Koc University Hospital and KUTTAM Research Center, Istanbul, Turkey.

Currently, there are no internationally accepted consensus guidelines for pathologic evaluation of posttherapy pancreatectomy specimens. The Neoadjuvant Therapy Working Group of Pancreatobiliary Pathology Society was formed in 2018 to review grossing protocols, literature, and major issues and to develop recommendations for pathologic evaluation of posttherapy pancreatectomy specimens. The working group generated the following recommendations: (1) Systematic and standardized grossing and sampling protocols should be adopted for pancreatectomy specimens for treated pancreatic ductal adenocarcinoma (PDAC). Read More

Medicina (Kaunas) 2021 Nov 12;57(11). Epub 2021 Nov 12.

Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.

Background: Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases.

Case Presentation: We report the case of a 60-year-old man who complained of a right-sided headache, blurred vision, progressive proptosis, ptosis, and right eye pain for 3 months. His past medical history included an ampullary adenocarcinoma stage IIIA treated via the Whipple procedure and adjuvant chemoradiotherapy 1 year ago. Read More

Gan To Kagaku Ryoho 2021 Nov;48(11):1401-1403

Dept. of Surgery, Yamamoto-Daisan Hospital.

A woman in her late 70s with fatigue, nausea, and epigastric discomfort was found to have a tumor at the papilla of Vater through endoscopy. We performed subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. The immunohistological analysis showed positive staining for chromogranin A, synaptophysin, and CD56. Read More

Cancer Prev Res (Phila) 2022 02 15;15(2):121-128. Epub 2021 Nov 15.

Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona.

Data from germline testing in unselected patients with hepatobiliary cancers are limited. Identification of germline predisposition can have important implications on cancer treatment and family counseling. To determine prevalence of pathogenic germline variants (PGV) in patients with hepatobiliary cancer, we undertook a prospective multi-site study of germline sequencing using a >80-gene next-generation sequencing platform among patients with hepatobiliary cancers receiving care at Mayo Clinic Cancer Centers between April 1, 2018 and March 31, 2020. Read More

Hepatology 2022 02;75(2):309-321

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.

Background And Aims: Gallbladder cancer (GBC) has a female predominance, whereas the other biliary tract cancers (BTCs) have a male predominance, suggesting that sex hormones may be involved in carcinogenesis. We sought to evaluate the association between menopausal hormone therapy (MHT) and the risk of BTC in women.

Approach And Results: This nested case-control study was conducted in the UK Clinical Practice Research Datalink. Read More

Arq Gastroenterol 2021 Jul-Sep;58(3):411-412

Hospital 9 de Julho, Serviço de Cirurgia, São Paulo, SP, Brasil.