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Endoscopic ampullectomy of a somatostatinoma
Journal Pre-proof Endoscopic ampullectomy of a somatostatinoma Arvind J. Trindade, Petros C. Benias, Steven Goldenberg
PII: DOI: Reference:
S1542-3565(20)30046-X https://doi.org/10.1016/j.cgh.2020.01.010 YJCGH 56953
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 5 January 2020 Please cite this article as: Trindade AJ, Benias PC, Goldenberg S, Endoscopic ampullectomy of a somatostatinoma, Clinical Gastroenterology and Hepatology (2020), doi: https://doi.org/10.1016/ j.cgh.2020.01.010. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 by the AGA Institute
Endoscopic ampullectomy of a somatostatinoma Arvind J Trindade (1), Petros C Benias (2), Steven Goldenberg (1)
(1) Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY ADDRESS CORRESPONDENCE: Dr. Arvind J. Trindade Director of Endoscopy Long Island Jewish Medical Center, Division of Gastroenterology Zucker School of Medicine at Hofstra/Northwell Northwell Health System 270-05 76th Avenue, New Hyde Park, NY 11040. Tel: (718) 470-7281; Fax: (718) 470-5509 e-mail: [email protected]
GRANT SUPPORT: None CONFLICT OF INTEREST DISCLOSURE: PCB is a consultant for Medtronic AJT is a consultant for Olympus America, Pentax America, and CSA Medical. AUTHORS CONTRIBUTIONS: Conception and design (AJT) Analysis and interpretation of the data (AJT,PCB, SG) Drafting of the article (AJT,PCB, SG)) Critical revision of the article for important intellectual content (AJT,PCB, SG)) Final approval of the article (AJT,PCB, SG)
Word count 197
Endoscopic ampullectomy of a somatostatinoma
A 49-year-old male with cutaneous neurofibromatosis (A) presented for evaluation of abnormal liver function tests . A magnetic resonance cholangiopancreatography showed a 7 mm ampullary nodule with an 8 mm pancreas duct and a 14 mm bile duct. Duodenoscopy (B) and endoscopic ultrasound was performed prior to endoscopic retrograde cholangiopancreatography (ERCP) that confirmed the lesion without invasion. A multi-disciplinary decision was made to resect the nodule endosocpically. ERCP with ampullectomy was performed without a submucosal injection of the lesion (C, arrow points to ampullectomy site and wire is in the bile duct). Both the bile duct and pancreatic duct were stented after resection. Histology revealed a 1.1 cm well differentiated neuroendocrine tumor (NET) involving the submucosa and muscularis propria with negative margins with a low mitotic rate and ki-67 index . Chromogranin and synaoptophysin stains were positive and psammomatous microcalcifications (arrow in figure D) were present; consistent with a somatostatinoma. Six-month follow-up showed no recurrence on dotatate positon emission tomography.
NET of the ampulla is rare with fewer than 1% of all NETs occurring here. However somatostatinomas of the ampulla are associated with neurofibromatosis and should be considered in the differential diagnosis of a dilated bile duct.
PII: DOI: Reference:
S1542-3565(20)30046-X https://doi.org/10.1016/j.cgh.2020.01.010 YJCGH 56953
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 5 January 2020 Please cite this article as: Trindade AJ, Benias PC, Goldenberg S, Endoscopic ampullectomy of a somatostatinoma, Clinical Gastroenterology and Hepatology (2020), doi: https://doi.org/10.1016/ j.cgh.2020.01.010. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 by the AGA Institute
Endoscopic ampullectomy of a somatostatinoma Arvind J Trindade (1), Petros C Benias (2), Steven Goldenberg (1)
(1) Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY ADDRESS CORRESPONDENCE: Dr. Arvind J. Trindade Director of Endoscopy Long Island Jewish Medical Center, Division of Gastroenterology Zucker School of Medicine at Hofstra/Northwell Northwell Health System 270-05 76th Avenue, New Hyde Park, NY 11040. Tel: (718) 470-7281; Fax: (718) 470-5509 e-mail: [email protected]
GRANT SUPPORT: None CONFLICT OF INTEREST DISCLOSURE: PCB is a consultant for Medtronic AJT is a consultant for Olympus America, Pentax America, and CSA Medical. AUTHORS CONTRIBUTIONS: Conception and design (AJT) Analysis and interpretation of the data (AJT,PCB, SG) Drafting of the article (AJT,PCB, SG)) Critical revision of the article for important intellectual content (AJT,PCB, SG)) Final approval of the article (AJT,PCB, SG)
Word count 197
Endoscopic ampullectomy of a somatostatinoma
A 49-year-old male with cutaneous neurofibromatosis (A) presented for evaluation of abnormal liver function tests . A magnetic resonance cholangiopancreatography showed a 7 mm ampullary nodule with an 8 mm pancreas duct and a 14 mm bile duct. Duodenoscopy (B) and endoscopic ultrasound was performed prior to endoscopic retrograde cholangiopancreatography (ERCP) that confirmed the lesion without invasion. A multi-disciplinary decision was made to resect the nodule endosocpically. ERCP with ampullectomy was performed without a submucosal injection of the lesion (C, arrow points to ampullectomy site and wire is in the bile duct). Both the bile duct and pancreatic duct were stented after resection. Histology revealed a 1.1 cm well differentiated neuroendocrine tumor (NET) involving the submucosa and muscularis propria with negative margins with a low mitotic rate and ki-67 index . Chromogranin and synaoptophysin stains were positive and psammomatous microcalcifications (arrow in figure D) were present; consistent with a somatostatinoma. Six-month follow-up showed no recurrence on dotatate positon emission tomography.
NET of the ampulla is rare with fewer than 1% of all NETs occurring here. However somatostatinomas of the ampulla are associated with neurofibromatosis and should be considered in the differential diagnosis of a dilated bile duct.