Clinical practice guidelines for endoscopic papillectomy

Itoi, Takao; Ryozawa, Shomei; Katanuma, Akio; Kawashima, Hiroki; Iwasaki, Eisuke; Hashimoto, Shinichi; Yamamoto, Kenjiro; Ueki, Toshiharu; Igarashi, Yoshinori; Inui, Kentaro; Fujita, Naotaka; Fujimoto, Kazuma

doi:10.1111/den.14233

Cited by 35 publications

(61 citation statements)

References 117 publications

(581 reference statements)

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“…No severe or fatal bleeding occur in the above 8 patients. The literature on ampullary papillectomy was examined, and it was found that the insertion of duct stent has been widely recommended by numerous endoscopists to reduce the risk of pancreatitis[ 25 - 27 ]. The autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon nearly 10 d after the operation.…”

Section: Discussionmentioning

confidence: 99%

Prospective single-center feasible study of innovative autorelease bile duct supporter to delay adverse events after endoscopic papillectomy

Liu¹,

Chai²,

Li³

et al. 2022

WJCC

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BACKGROUND Conventional endoscopic papillectomy (EP) is safe and effective for the treatment of small papilla adenoma to even large laterally spreading tumors of duodenum lesions. As reported by some existing studies, temporarily placing a prophylactic stent in the pancreatic and bile duct can lower the risk of this perioperative complication. AIM To evaluate the usefulness, convenience, safety, and short-term results of a novel autorelease bile duct supporter after EP procedure, especially the effectiveness in preventing EP. METHODS A single-center comparison study was conducted to verify the feasibility of the novel method. After EP, a metallic endoclip and human fibrin sealant kit were applied for protection. The autorelease bile duct supporter fell into the duct segment and the intestinal segment. Specifically, the intestinal segment was extended by nearly 5 cm as a bent coil. The bile was isolated from the pancreatic juice using an autorelease bile duct supporter, which protected the wound surface. The autorelease bile duct supporter fell off naturally and arrived in colon nearly 10 d after the operation. RESULTS En bloc endoscopic resection was performed in 6/8 patients (75%), and piecemeal resection was performed in 2/8 of patients (25%). None of the above patients were positive for neoplastic lymph nodes or distant metastasis. No cases of mortality, hemorrhage, delayed perforation, pancreatitis, cholangitis or duct stenosis with the conventional medical treatment were reported. The autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon 10 d after the operation. One autorelease bile duct supporter was successfully removed using forceps or snare under endoscopy. No recurrence was identified during the 8-mo (ranging from 6-9 mo) follow-up period. CONCLUSION In brief, it was found that the autorelease bile duct supporter could decrease the frequency of procedure-associated complications without second endoscopic retraction. Secure closure of the resection wound with clips and fibrin glue were indicated to be promising and important for the use of autorelease bile duct supporters. Well-designed larger-scale comparative studies are required to confirm the findings of this study.

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Section: Discussionmentioning

confidence: 99%

Prospective single-center feasible study of innovative autorelease bile duct supporter to delay adverse events after endoscopic papillectomy

Liu¹,

Chai²,

Li³

et al. 2022

WJCC

View full text Add to dashboard Cite

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“…3 The prophylactic use of rectal diclofenac and pancreatic duct stenting are recommended to reduce the risk of post-papillectomy pancreatitis. 1,2 Prophylactic argon plasma coagulation did not reduce the risk of post-papillectomy bleeding. 4 Endoscopic clip placement while using a duodenoscope can be challenging, but there is a suggestion that placement of a duodenoscope-compatible clip may potentially reduce the risk of bleeding.…”

mentioning

confidence: 97%

“…However, surgery remains the treatment of choice when endoscopic papillectomy is technically challenging, in the presence of intraductal extension greater than 10 mm, and once malignant transformation has occurred. 1,2 The two most common major complications that can occur after endoscopic papillectomy are post-papillectomy pancreatitis (11.9%, 95% confidence interval [CI] 10.4-13.6%) and bleeding (10.6%, 95%CI 8.2-13.6). 3 The prophylactic use of rectal diclofenac and pancreatic duct stenting are recommended to reduce the risk of post-papillectomy pancreatitis.…”

mentioning

confidence: 99%

“…Another related issue is the risk of pancreatitis, because the hemostatic powder can potentially obstruct the pancreatic duct orifice for a prolonged period of time. Although pancreatic duct stenting is recommended post-endoscopic papillectomy, 1,2 in some patients, it may not be successful, and hence, caution should be exercised when considering the application of hemostatic powder for this group.…”

mentioning

confidence: 99%

“…Endoscopic papillectomy with en bloc resection to achieve R0 resection is now recommended as first‐line treatment for ampullary adenomas due to good clinical outcome data and lower morbidity compared with surgery. However, surgery remains the treatment of choice when endoscopic papillectomy is technically challenging, in the presence of intraductal extension greater than 10 mm, and once malignant transformation has occurred 1,2 . The two most common major complications that can occur after endoscopic papillectomy are post‐papillectomy pancreatitis (11.9%, 95% confidence interval [CI] 10.4–13.6%) and bleeding (10.6%, 95%CI 8.2–13.6) 3 .…”

mentioning

confidence: 99%

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