Discrepancies in Biopsy Results in Pre- Versus Post-Endoscopic Ampullectomies

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Purpose: Endoscopic ampullectomy is used to remove the ampulla for patients with malignant or pre-malignant lesions at the ampulla and who are not candidates for surgery. We have experienced a number of patients whose biopsy pathology reports have shown discrepancies between pre- versus post-ampullectomies. The purpose of this retrospective study is to determine the frequency of discrepancies in biopsy pathology reports in pre- versus post-endoscopic ampullectomies and the possible cause for that.

Methods: All patients who had undergone endoscopic ampullectomies at Emory University Hospital from January 2003 to April 2009 were selected for this study. The following data were collected for analysis: patient age, patient sex, patient medical histories, and pathology reports on both pre-endoscopic and post-endoscopic ampullectomies.

Results: A total of eight patients were found during this time. Among them, four patients had a history of familial adenomatous polyposis (FAP); the other four had no relevant histories. Six patients had tubular adenomas, one had tubulo-villous adenoma, and one had carcinoma in situ on their pathology reports before ampullectomy. Following ampullectomy, three of the four patients who had FAP had the same pathology diagnosis as prior to ampullectomy; the other one had a normal pathology on the post-ampullectomy sample. Only one of the four patients with no relevant histories had the same pathology diagnosis as prior to ampullectomy; the other three had normal pathologies on the post-ampullectomy samples.

Table: Comparison of age, gender, pre- versus post-endoscopic ampullectomy biopsy pathology reports, and medical histories in patients at Emory University Hospital from January 1993 to April 2009

Conclusion: In this study, 75% of the patients with no relevant histories had normal pathologies on the post-ampullectomy biopsies. In contrast, 75% of the patients with FAP had adenomas on the post-ampullectomy samples. Perhaps, for patients without FAP, performing a very limited ampullectomy may be sufficient to decrease the possibility of perforation.