Clinical impact of endoscopic papillectomy for benign-malignant borderline lesions of the major duodenal papilla

Harano, Megumi; Ryozawa, Shomei; Iwano, Hirotoshi; Taba, Kumiko; Sen-yo, Manabu; Sakaida, Isao

doi:10.1007/s00534-010-0327-8

Cited by 29 publications

(26 citation statements)

References 25 publications

(70 reference statements)

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“…However, the study involved a small number of patients and the reason for statistical significance despite this small number was the absence of pancreatitis in patients who received prophylactic pancreatic duct stent placement. In common with the study of Harewood et al,5 two retrospective studies showed no postprocedure pancreatitis development in patients with prophylactic pancreatic stent placement 18,19. However, there were some differences in the procedures between two of three studies and this study.…”

Section: Discussionsupporting

confidence: 79%

“…The success rate may be lower in endoscopic papillectomy than other ERCP procedure due to bleeding, edema, or cautery artifact after resection. In a study of endoscopic papillectomy by Harano et al,19 the success rate was 82% (23/28). In our study, the pancreatic stent insertion success rate was 72% (54/74) and one case of postprocedure pancreatitis developed in one of 20 patients for whom pancreatic stent placement failed, due to cannulation failure.…”

Section: Discussionmentioning

confidence: 95%

“…We did not perform the biliary sphincterotomy, however in the study of Harewood et al,5 biliary sphicterotomy was performed routinely, and in the study of Desilets et al,18 routine biductal sphincterotomy was performed. In the study of Harano et al,19 bile duct stenting was routinely done. In some other studies, postprocedure pancreatitis developed in patients who received prophylactic pancreatic stent 2,6,7,8,20,21,22.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Chang¹,

Ye²,

Yun³

et al. 2014

Gut Liver

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Background/AimsWe investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy.MethodsThis retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis.ResultsThere was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection.ConclusionsOur data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Chang¹,

Ye²,

Yun³

et al. 2014

Gut Liver

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“…Previous reports of EP procedures have described completion rates of 77% to 84%. 10 , 12 , 13 In this study, we achieved a 100% success rate for en bloc resection using the double-snare retracting papillectomy technique. Although this study included only a small number of patients, the results are certainly encouraging, and further data will be accumulated in the future.…”

Section: Discussionmentioning

confidence: 71%

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

et al. 2015

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We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

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“…6,[8][9][10] Most gastrointestinal mucosal tumors, such as colonic polyps or early gastric cancers, can be lifted from the submucosal layer by injecting saline solution or diluted epinephrine solution into the submucosal layer beneath the lesion of the gastrointestinal wall. This submucosal injection (SI) is thought to yield wider resection margins and prevent perforation and hemorrhage and is therefore commonly conducted when performing endoscopic mucosal resection or endoscopic submucosal dissection of such tumors, 11,12 as well as in endoscopic papillectomy.…”

mentioning

confidence: 99%

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

et al. 2018

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Background: The role of submucosal injection (SI) in endoscopic papillectomy (EP) is controversial. Objective: This study investigated the effects of SI before EP of ampullary tumors. Methods: All patients who underwent initial curative EP at our institution between March 2006 and March 2014 were retrospectively recruited. The presence of residual tumor after three months, recurrence-free survival and post-procedural adverse events were compared between the SI group and non-injection (NI) group. Propensity-score matching was performed between the two groups to reduce potential selection bias and confounding. Results: A total of 122 patients were included (SI: 26, NI: 96). Following propensity-score matching, 25 paired patients were selected. Residual tumor was not shown in the NI group, whereas seven (28.0%) patients in the SI group had residual tumor (p ¼ 0.010). The recurrence-free survival of the NI group was significantly longer than that of the SI group (p ¼ 0.036). Upon multivariate analysis, pathologic grade (p ¼ 0.026) and SI (p ¼ 0.033) were significantly related to recurrence-free survival. Post-procedural adverse events were not significantly different between the two groups. Conclusion: SI before EP of ampullary tumor was related to more frequent residual tumor and shorter recurrence-free survival and did not reduce post-procedural adverse events.

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Clinical impact of endoscopic papillectomy for benign-malignant borderline lesions of the major duodenal papilla

Cited by 29 publications

References 25 publications

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

Effect of submucosal injection in endoscopic papillectomy of ampullary tumor: Propensity‐score matching analysis

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