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

Abstract

Background and Aims Endoscopic submucosal dissection (ESD) for superficial duodenal epithelial tumors (SDETs) is technically difficult and has a high risk of adverse events. Endoscopic nasobiliary and nasopancreatic duct drainage (ENBPD) may reduce the risk of delayed adverse events by preventing exposure of the post‐ESD mucosal defect to bile and pancreatic juice. This study was performed to evaluate the safety and feasibility of ENBPD after duodenal ESD. Methods Patients who underwent ESD for SDETs from July 2010 to March 2020 were included. We collected data on the success rate of ENBPD, adverse events due to insertion of a side‐viewing endoscope, and pancreatitis after ENBPD. We also collected the clinical outcomes of duodenal ESD, including the incidence rate of delayed adverse events (defined as bleeding or perforation found after the endoscopic procedure). Results Among 70 patients without complete closure of the post‐ESD mucosal defect, ENBPD was successfully performed in all 25 patients including 21 cases inserted immediately after ESD and four cases inserted later. There were no adverse events associated with ENBPD procedure intraoperatively, while pancreatitis after ENBPD occurred in four patients (16.0%). No patients who underwent immediate ENBPD required intervention for an intra‐abdominal abscess or delayed perforation, whereas 3 of 49 patients (6.1%) who did not undergo immediate ENBPD required surgery or drainage of an abscess. Conclusions Endoscopic nasobiliary and nasopancreatic duct drainage is technically feasible and might provide effective prophylaxis for delayed adverse events, even if a large mucosal defect is present after ESD.

Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

“…Figures 1 and 2 illustrate representative clip-based techniques (hold-and-drag using repositionable clip [QuickClip Pro, HX-202UR; Olympus], 83 EPSS using detachable endoloop, 85 line-assisted complete closure, 78 mucosa-submucosa clip, 17,86 underwater clip closure, 87 and E-LOC 13 ), mechanical clipping (OTSC with clips 14,38,46 ), and surgical stitch-based techniques (OverStitch 15 and EHS 10,90 ).…”

ESD for duodenal carcinoma

“…We analyzed clinical courses of cases with perforation of duodenal ESD and found that closing the whole area of mucosal defect as well as perforation site improved clinical outcomes. The maximum C-reactive protein value and length of hospital stay of cases where the mucosal defect was closed completely were almost equivalent to those without perforation [44] . Closing the mucosal defect enables managing the patients conservatively in the case of intraprocedural perforation as well as helps avoid delayed AE [Figure 3].…”

Successful endoscopic resection by using gel immersion and the technique of endoscopic papillectomy for a tumor adjacent to the papilla of Vater

“…In cases where closure of the entire mucosal defect is not possible and/or when a lesion is located near the POV, insertion of endoscopic nasobiliary drainage (ENBD) and endoscopic nasopancreatic drainage (ENPD) tubes for external drainage of biliary and pancreatic juices after ESD is reportedly effective at preventing delayed bleeding and perforation. 11,12 Therefore, a bile duct stent and pancreatic duct stent were placed before treatment to improve lesion visualization and avoid ductal injury during ESD. The stents also facilitated the insertion of ENBD and ENPD tubes after resection (Fig.…”