Imaging tumours of the ampulla of Vater

Although comparatively rare, ampullary tumours tend to be more readily curable than periampullary lesions and pancreatic carcinomas, consequent upon an earlier presentation, a lower likelihood of involved lymph nodes or vascular infiltration and a less aggressive histology. Recently, selected early cases have been able to resected endoscopically making accurate preoperative tumour (T) staging critical in such decision making. The most commonly available imaging methods are endoscopic ultrasound (EUS) and CT scanning where in the former case there is variable accuracy for larger (T2/T3) ampullary tumours particularly where the patient has undergone preoperative common bile duct stenting. CT scanning has consistent shown inferior T staging of ampullary tumours when compared with EUS, although it provides information concerning visceral and nodal metastatic disease. Transpapillary intraductal ultrasound (where available) has shown high accuracy for early T1 tumours potentially suitable for endoscopic or local ampullary excision with the added advantage that it may be conducted without preliminary sphincterotomy. Recently, our group has been using intraoperative transduodenal ultrasound which assists surgical decision making concerning local excision or radical pancreaticoduodenal resection. Very recent images using 3-dimensional endoduodenal ultrasound has provided exquisite images of the ampulla and remain to be validated in ampullary neoplasms.