Korean Journal of Gastrointestinal Endoscopy 2008;37(3): 185-191.
육안으로 정상적인 파터 팽대부암의 감별진단과 예후
정지봉ㆍ김용태*ㆍ정용진ㆍ김지원ㆍ김병관ㆍ이국래ㆍ류지곤*ㆍ윤용범*
서울대학교 보라매병원, *서울대학교 의과대학 내과학교실
The Differential Diagnosis and Prognosis of an Ampulla of Vater Cancer with a Grossly Normal Appearance
Ji Bong Jeong, M.D., Yong-Tae Kim, M.D.*, Yong Jin Jung, M.D., Ji Won Kim, M.D., Byung Kwan Kim, M.D., Kook Lae Lee, M.D., Ji Kon Ryu, M.D.* and Yong Bum Yoon, M.D.*
Department of Internal Medicine, Seoul National University Boramae Hospital, *Seoul National University College of Medicine, Seoul, Korea
Abstract
Background/Aims: The purpose of this study was to determine the clinical parameters for a differential diagnosis between a malignant and benign stricture of the ampulla of Vater with a grossly normal appearance and to evaluate the diagnostic accuracy of the use of an endoscopic biopsy for the prognosis of ampulla of Vater cancers. Methods: Medical records and cholangiograms were retrospectively reviewed. In order to determine the clinical parameters useful for a differential diagnosis, clinical manifestations, laboratory findings and the common bile duct diameter were compared between malignant and benign strictures. The diagnostic accuracy of the use of an endoscopic biopsy and the clinical features of patients with an ampulla of Vater cancer were analyzed. The survival rate after management was also evaluated. Results: Nine patients with a benign stricture and 15 patients with a malignant stricture were included in this study. The levels of serum bilirubin, alkaline phosphatase and alanine aminotransferase were significantly higher in patients with a malignant stricture than in patients with a benign stricture (p＜0.05). Of the patients who underwent surgical management, 93% had stage I or II disease. All of the patients were alive up to a mean follow-up period of 50 months. Conclusions: Liver function tests and the use of an endoscopic biopsy are useful in the differential diagnosis of a stricture of the ampulla of vater with a grossly normal appearance. Cancer patients typically present with an early stage and the prognosis is relatively good. (Korean J Gastrointest Endosc 2008;37:185-191)
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