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

Abstract

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.

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

“…After screening of titles and abstracts, 367 studies remained. Finally, 59 papers were eligible to be included into the meta-analysis after full-text evaluation (42 EA, 8 SA, 1 PD, 3 SA + PD, 4 EA + SA, 1 EA + PD; Figure 1 PRISMA chart) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ...…”

“…Moreover, in 40.4% of patients with EA, a prior submucosal injection was performed to lift the lesions. A submucosal injection is not recommended as such injection resulted in reduced rates of complete resection [10,31,41,80]. Furthermore, in some EA studies, additional therapy by radiofrequency ablation (RFA), argon plasma coagulation (APC), additional EA or surgery was performed.…”

Endoscopic Papillectomy for Early Ampullary Neoplastic Lesions - A Case Series Analysis

“…The arguments for the use of submucosal injection are a reduction in the risk of bleeding when associated with adrenaline, besides the creation of a cushion with separation of the superficial and deep layers. However, this has been abolished by many centers because it increases the difficulty of grasping the lesion and the risk of pancreatitis (21) . In our series, submucosal injection with a saline solution containing adrenaline was used in only two procedures.…”

Methods and outcome of the endoscopic treatment of ampullary tumors

“…A recent study compared the clinical outcomes of endoscopic papillectomy with and without submucosal injection and concluded that routine submucosal injection is associated with more frequent residual tumor and shorter recurrence-free survival, without reducing post-procedural adverse events. 38 Polypectomy snares. No superiority has either been proven between different materials for polypectomy snares, although in most reports, standard braided stainless steel wire have been used.…”

“…A recent study compared the clinical outcomes of endoscopic papillectomy with and without submucosal injection and concluded that routine submucosal injection is associated with more frequent residual tumor and shorter recurrence-free survival, without reducing post-procedural adverse events. 38…”