Electric Endocut and Autocut Resection for Endoscopic Papillectomy: A Systematic Review

Abstract

Objective Risks of bleeding and pancreatitis after mucosal resection using the purecut/autocut and blendcut/endocut modes for endoscopic papillectomy have not been fully clarified. Thus, a systematic review on electrosurgical cutting modes for endoscopic papillectomy was conducted focusing on the types and incidence of adverse events. Methods We searched the PubMed and Cochrane library for cases of endoscopic papillectomy recorded as of April 2017. Studies reporting the methods of electrically excising a tumor in the duodenal papilla and the number of adverse events were extracted. Studies were collected and examined separately based on the electrosurgical cutting mode, and the incidence rate for each adverse event was summarized. Results A total of 159 relevant articles were found; among them, 20 studies were included and 139 excluded. Five studies analyzed endoscopic papillectomy with the purecut/autocut mode and 16 with the blendcut/endocut mode. Only one study investigated both modes (purecut and endocut). With the purecut/autocut mode, the incidence of bleeding was 2.8-50%, and that of pancreatitis was 0-50% (mean: 12.8%). With the blendcut/endocut mode, the incidence of bleeding was 0-42.3%, and that of pancreatitis was 0%-17.9% (mean: 9.5%). Conclusion Both methods had high adverse event rates for endoscopic papillectomy. Thus, a standard method of endoscopic papillectomy, including the electrosurgical cutting mode, needs to be established.

External drainage of bile and pancreatic juice after endoscopic submucosal dissection for duodenal neoplasm: Feasibility study (with video)

“…This rate is higher than that in previous reports involving the general ERCP procedure (4.9%–7.2%) 12,15,16 . but similar to the reported incidence after endoscopic papillectomy (up to 17.9%) 17–20 . Although the risk of adverse events including PEP and intraoperative perforation due to injury by endoscope is not negligible, delayed adverse events have higher risk of worse clinical course and may require additional invasive treatments including surgical operation for management.…”

“…12,15,16 but similar to the reported incidence after endoscopic papillectomy (up to 17.9%). [17][18][19][20] Although the risk of adverse events including PEP and intraoperative perforation due to injury by endoscope is not negligible, delayed adverse events have higher risk of worse clinical course and may require additional invasive treatments including surgical operation for management. Thus, ENBPD might be an option for prevention of delayed adverse events when complete closure is impossible to perform, considering the high morbidity rate in patients without complete closure.…”

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Others prefer using a blended electrosurgical current [80,86] or alternating cut/coagulation modes [21,158]. A systematic review of non-RCTs did not demonstrate superiority of one modality over the other [168]. In a retrospective case-control trial focusing on adverse events with respect to technical modifications of papillectomy, the use of endocut instead of pure cutting current resulted in a significant reduction of early bleeding without any consequence observed in terms of cannulation rate of the pancreatic orifice and post-ERCP pancreatitis rate [154].…”

Endoskopische Papillektomie – Schritt für Schritt

“…Aufgrund der zumeist im Resektat enthaltenen Gang- und Muskelanteile muss eine „heiße Schlinge“ unter Verwendung eines Hochfrequenz-Stromgenerators genutzt werden. Zwar ist nicht etabliert, ob reiner Schneidestrom („Auto-cut-Modus“) oder eine Kombination aus Schneide- und Koagulationsstrom („Endo-cut-Modus“) bessere Ergebnisse bringt, letztere scheint aber das Blutungsrisiko zu senken – allerdings auf Kosten der Präparatqualität 4 .…”