PubMed · 5431943
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L Demling, M Classen. 1970-07-03. [Duodenojejunoscopy].. https://doi.org/10.1055/s-0028-1108660
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BACKGROUND AND STUDY AIMS: Some patients admitted for endoscopy present a gastrojejunostomy with a Billroth II anastomosis or Roux-en-Y reconstruction. The gastrointestinal reconstruction hampers endoscopic diagnosis and treatment of the biliary and pancreatic tract. The present paper describes a new procedure facilitating endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone gastrojejunostomy. PATIENTS AND METHODS: ERCP was attempted in 65 patients with gastrojejunostomy. A conventional side-viewing endoscope was advanced into the duodenal stump, and a modified catheter was pushed through the endoscope. The cutting wire of the modified catheter winds round the catheter at a pivotal point between the catheter's proximal and distal holes. This allows the catheter tip to be forced into an S-shape when the wire is pulled. Since the cutting wire can easily be adjusted to the papillary roof, safe and successful endoscopic sphincterotomy can be carried out. RESULTS: We were able to advance the conventional side-viewing endoscope into the duodenal stump in 92% of the patients (n = 59) with Billroth II gastrojejunostomies, and in 33% of the patients (n = 6) with Roux-en-Y anastomoses. Whenever it was possible to reach the duodenal stump, cannulation and sphincterotomy of the papilla of Vater was successful. Ninety-six percent of the patients who underwent sphincterotomy (n = 54) immediately benefited from biliary decompression. One major complication occurred, with a patient suffering a retroperitoneal perforation during endoscopic sphincterotomy; the patient later died, despite three subsequent surgical operations. CONCLUSIONS: In spite of previous gastrojejunostomy, most patients with Billroth II anastomoses (92%) and many patients with Roux-en-Y reconstructions (33%) can be treated endoscopically for biliary diseases. The use of a conventional side-viewing endoscope in conjunction with an S-shaped sphincterotome can be recommended. This allows safe and successful endoscopic treatment of all patients in whom endoscopic access to the papilla of Vater is possible.
Sarcomatoid carcinomas (carcinosarcomas) are rare lesions in the gastrointestinal tract, where they are most commonly found in the esophagus. We present the first reported case of a sarcomatoid carcinoma of the ampulla of Vater. The tumor was composed of intermixed carcinomatous (adenocarcinoma plus squamous cell carcinoma) and sarcomatous elements. Cytokeratin immunoreactivity was demonstrated focally in the sarcomatoid component, although in other areas there was positive staining for desmin and smooth muscle actin. The possible histogenesis of such lesions is briefly discussed.
We report the case of a 56-year-old woman who presented with biliary obstruction due to a neoplasm involving the duodenum in the area of the ampulla of Vater and the head of the pancreas. Clinically and radiographically, she was thought to have pancreatic carcinoma. Histologic examination of the specimen from a Whipple procedure revealed malignant lymphoma, follicle center type, follicular, grade 1 of 3 (follicular, predominantly small cleaved cell type), arising in the duodenum and invading the pancreas. Five peripancreatic lymph nodes were partially involved by lymphoma. Follicle center lymphoma presenting as a mass involving the ampulla of Vater with jaundice has not been described previously. Our case indicates that this type of lymphoma can occur in this location and can present with features that mimic pancreatic carcinoma.