Biopsy of the Vater nipple

Biopsy of the Vater nipple — is the taking of a tissue sample from the confluence of the common bile duct and pancreatic duct into the duodenum. This is a technically complex and extremely responsible study performed during endoscopy (EGD or ERCP) for the differential diagnosis between benign changes and tumors in this area.

Research objective: The main task is to determine the cause of the obstruction of bile or pancreatic secretion. Since the papilla of Vater has a complex anatomical structure, pathomorphological analysis is the only way to distinguish inflammatory edema (papilitis) or stenosis from adenoma or cancer (ampullary carcinoma).

What does the pathologist evaluate:

• Epithelium type: assessment of changes in the mucous membrane in the ampulla area.

• Presence of adenoma: detection of benign growths that have a high potential to degenerate into cancer.

• Signs of malignancy: search for atypical cells indicating the development of adenocarcinoma.

• Degree of dysplasia: assessment of precancerous changes in nipple tissues.

• Inflammatory changes: diagnosis of chronic papillitis, which can cause mechanical jaundice.

Clinical significance: The biopsy results determine the radicality of further treatment. If a benign adenoma is detected, its endoscopic removal (papilectomy) is possible. If a malignant process is confirmed, the patient usually requires a complex surgical operation (pancreatoduodenal resection).

When is it prescribed:

• visual thickening, deformation, or enlargement of the nipple of Vater during endoscopy;

• mechanical jaundice of unknown origin;

• dilation of the bile or pancreatic ducts according to ultrasound, MRI or CT scan;

• suspected tumor of the ampullary zone;

• control after endoscopic removal of neoplasms of this location.