Efficacy of cap-assisted forward-viewing endoscopy as a method for evaluation of ampulla of Vater.

Abstract

Endoscopic evaluation of ampulla of Vater, although routinely recommended, is not always possible due to its anatomic configuration that can hide it from the visual field of the forward-viewing endoscope. Cap-assisted forward-viewing endoscopy has been proposed as a useful alternative to facilitate the examination of this structure.\n\n\nOBJECTIVES\nAssess the efficacy of cap-assisted forward-viewing endoscopy for the complete evaluation of the ampulla of Vater (AV). Secondary outcomes were to assess AV morphology, search and total procedure times, and technique safety.\n\n\nMETHODS\nProspective, single-arm study. We included patients who were selected for elective upper endoscopy. We excluded patients with advanced neoplasia, modified anatomy, upper gastrointestinal stenosis, or obstructions.\n\n\nOUTCOMES\nWe included 90 patients, 36 men (40%) and 54 women (60%). Fifteen percent had a history of hereditary colon cancer syndrome. Technical success of cap-assisted, forward-viewing endoscopy was 98.8%. AV was classified as type 1 (classic) in 49.4%, type 2 (small) in 16.8%, type 3 (protruding) in 11.2% and type 4 (ridged) in 22.4%. Mean search time was 37.7 s (SD ±31.6) and total procedure time was 487.4 s (SD ±206.2). No adverse events were reported.\n\n\nCONCLUSIONS\nCap-assisted forward-viewing endoscopy is an effective and safe technique for complete visualization and morphologic characterization of the ampulla of Vater.