Usefulness of pancreatic duct wire-guided endoscopic papillectomy for ampullary adenoma for preventing post-procedure pancreatitis

Abstract

Pancreatic duct wire-guided endoscopic snare papillectomy for ampullary adenoma effectively facilitated pancreatic duct stenting to prevent severe post-procedure pancreatitis.

Analysis of risk factors associated with acute pancreatitis after endoscopic papillectomy

“…Theoretically, these results suggest that patients undergoing PPS placement are 6.43 times more likely to develop AP. This finding differs from the literature 3,5,6,8,21,[30][31][32][33] . It should be noted that this is a retrospective, nonrandomized study, which precludes causal inferences about the relationship between the procedures.…”

Pancreatic intubation facilitated by methylene blue injection decreases the risk for postpapillectomy acute pancreatitis

“…Before papillectomy and after PD cannulation with a hydrophilic guide-wire, all patients received a prudent retrograde PD injection of MB. More recently, a new technique, using wire-guided endoscopic snaring of the PD before resection, demonstrated successful PD stenting in 72 consecutive patients after endoscopic papillectomy [37]. This innovative technique is simple and can be considered as safe because it does not increase the risk of postprocedure pancreatitis.…”

The role of endoscopy in ampullary and duodenal adenomas

“…46,54,69 Pancreatic duct stent placement typically is performed after papillectomy and may be facilitated by wire-guided papillectomy. 83 The only prospective, randomized, controlled trial to evaluate the role of prophylactic pancreatic duct stenting for the reduction of post-ERCP pancreatitis after endoscopic papillectomy showed a statistically significant decrease in the rate of postprocedural pancreatitis in the stent group, although only 19 patients were enrolled in the trial. 87 On the basis of this and nonrandomized data, 88,90 prophylactic pancreatic duct stenting during papillectomy is recommended to reduce the risk of postprocedural pancreatitis.…”

“…Retrieval of the specimen is facilitated by perpendicular needle-knife incision of the snared specimen to release it from the wire or stent. 82,83 Piecemeal resection with electrocautery often is performed for lesions >2 cm or for cases in which visible neoplastic tissue remains after attempted en bloc resection. Piecemeal resection may produce electrocauteryrelated injury to tissue fragments sent for pathology analysis and may require repeated submucosal injections to achieve sustained elevation of adenomatous tissue.…”