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endoscopic papillectomy: Indications, techniques, and results

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World Journal of Gastroenterology 2014年第6期20卷 1537-1543页

作者： Giovanni D De Palma Center of Excellence for Technical Innovation in Surgery Department of Clinical Medicine and Surgery University of Naples Federico Ⅱ School of Medicine

endoscopic papillectomy (EP) is currently accepted as a viable alternative therapy to surgery in sporadic ampullary adenoma and has been reported to have high success and low recurrence rates. At present, the indications for EP are not yet fully established. The accepted criteria for EP include size (up to 5 cm), no evidence of intraductal growth, and no evidence of malignancy on endoscopic findings (ulceration, friability, and spontaneous bleeding). endoscopic ultrasound (EUS) is the imaging modality of choice for local T staging in ampullary neoplasms. Data reported in the literature have revealed that linear EUS is superior to helical computed tomography in the preoperative assessment of tumor size, detection of regional nodal metastases and detection of major vascular invasion. endoscopic ampullectomy is performed using a standard duodenoscope in a similar manner to snare polypectomy of a mucosal lesion. There is no standardization of the equipment or technique and broad EP methods are described. endoscopic ampullectomy is considered a ‘‘high-risk’’ procedure due to complications. Complications of endoscopic papillectomy can be classified as early (pancreatitis, bleeding, perforation, and cholangitis) and late (papillary stenosis) complications. The appropriate use of stenting after ampullectomy may prevent post-procedural pancreatitis and papillary stenosis. Tumor recurrence of benign lesions occurs in up to 20% of patients and depends on tumor size, final histology, presence of intraductal tumor, coexisting familial adenomatous polyposis (FAP), and the expertise of the endoscopist. Recurrent lesions are usually benign and most can be retreated endoscopically.

关键词： endoscopic papillectomy Papillary neoplasms Major duodenal papilla endoscopic retrograde cholangiopancreatography endoscopic sphincterotomy

Novel endoscopic papillectomy for reducing postoperative adverse events(with videos)

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World Journal of Gastroenterology 2020年第40期26卷 6250-6259页

作者： Lei Jiang En-Qiang Ling-Hu Ning-Li Chai Wen Li Feng-Chun Cai Ming-Yang Li Xu Guo Jiang-Yun Meng Xiang-Dong Wang Ping Tang Jing Zhu Hong Du Hong-Bin Wang School of Medicine Nankai UniversityTianjin 300071China Department of Gastroenterology and Hepatology Chinese People's Liberation Army General HospitalBeijing 100853China

BACKGROUND Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical adverse events that restrict its wider use. There is no standard procedure for endoscopic papillectomy yet. The procedure is relevant to postoperative adverse *** To reduce the postoperative adverse event rates and improve patients' postoperative condition, we developed a standard novel procedure for endoscopic *** The novel endoscopic papillectomy had two main modifications based on the conventional method: The isolation of bile from pancreatic juice with a bile duct stent and wound surface protection with metal clips and fibrin glue. We performed a single-center retrospective comparison study on the novel and conventional methods to examine the feasibility of the novel method for reducing postoperative adverse *** A total of 76 patients, of whom 23 underwent the novel procedure and 53 underwent the conventional procedure, were retrospectively evaluated in this study. The postoperative bleeding and pancreatitis rates of the novel method were significantly lower than those of the conventional method(0 vs 20.75%, P = 0.028, and 17.4% vs 41.5%, P = 0.042, respectively). After applying the novel method, the most critical adverse event, perforation, was entirely prevented, compared to a prevalence of 5.66% with the conventional method. Several postoperative symptoms, including fever, rapid pulse, and decrease in hemoglobin level, were significantly less frequent in the novel group(P = 0.042, 0.049, and 0.014, respectively). Overall, the total adverse event rate of the novel method was lower(0 vs 24.5%, P = 0.007) than that of the conventional *** Patients who underwent the novel procedure had lower postoperative adverse event ra

关键词： endoscopic papillectomy Novel technique Adverse events Papillary adenoma endoscopic retrograde cholangiopancreatography Bile duct stent

endoscopic pancreaticobiliary drainage with overlength stents to prevent delayed perforation after endoscopic papillectomy:A pilot study

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World Journal of Gastroenterology 2020年第44期26卷 7036-7045页

作者： Liang Wu Fang Liu Nan Zhang Xiao-Peng Wang Wen Li International Center for Diagnosis and Treatment of Liver Diseases The Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China Department of Gastroenterology and Hepatology The First Medical Center of Chinese PLA General HospitalBeijing 100853China Department of Gastroenterology and Hepatology Chinese PLA 305 HospitalBeijing 100017China

BACKGROUND endoscopic papillectomy(EP)is rapidly replacing traditional surgical resection and is a less invasive procedure for the treatment of duodenal papillary tumors in selected *** the expansion of indications,concerns regarding EP include not only technical difficulties,but also the risk of complications,especially delayed duodenal *** perforation after EP is a rare but fatal *** of the artificial ulcer to bile and pancreatic juice is considered to be one of the causes of delayed perforation after *** bile and pancreatic juice away from the wound may help to prevent delayed *** To evaluate the feasibility and safety of placing overlength biliary and pancreatic stents after *** This is a single-center,retrospective *** patients with exposure or injury of the muscularis propria after EP were included.A 7-Fr overlength biliary stent and a 7-Fr overlength pancreatic stent,modified by an endoscopic nasobiliary drainage tube,were placed in the common bile duct and pancreatic duct,respectively,and the bile and pancreatic juice were drained to the proximal *** EP and overlength stents placement were technically feasible in all five patients(63±12 years),with an average operative time of 63.0±5.6 *** the five lesions(median size 20 mm,range 15-35 mm),four achieved en bloc excision and curative *** final histopathological diagnoses of the endoscopic specimen were one tubular adenoma with high-grade dysplasia(HGD),one tubulovillous adenoma with low-grade dysplasia,one hamartomatous polyp with HGD,one poorly differentiated adenocarcinoma and one atypical juvenile polyposis with tubulovillous adenoma,HGD and field cancerization invading the muscularis mucosae and *** were no stent-related complications,but one papillectomy-related complication(mild acute pancreatitis)occurred without any episodes of bleeding,perforation,cholangitis or late-onset duct stenosis.

关键词： endoscopic papillectomy Major duodenal papilla Delayed perforation Overlength stent endoscopic retrograde cholangiopancreatography Duodenal papillary tumors

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

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World Journal of Clinical Cases 2022年第22期10卷 7785-7793页

作者： Sheng-Zhen Liu Ning-Li Chai Hui-Kai Li Xiu-Xue Feng Ya-Qi Zhai Nan-Jun Wang Ying Gao Fei Gao Sha-Sha Wang En-Qiang Linghu Department of Gastroenterology and Hepatology Chinese PLA General HospitalBeijing 100853China

BACKGROUND Conventional endoscopic papillectomy(EP)is safe and effective for the treatment of small papilla adenoma to even large laterally spreading tumors of duodenum *** reported by some existing studies,temporarily placing a prophylactic stent in the pancreatic and bile duct can lower the risk of this perioperative *** 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 *** A single-center comparison study was conducted to verify the feasibility of the novel *** EP,a metallic endoclip and human fibrin sealant kit were applied for *** autorelease bile duct supporter fell into the duct segment and the intestinal ***,the intestinal segment was extended by nearly 5 cm as a bent *** bile was isolated from the pancreatic juice using an autorelease bile duct supporter,which protected the wound *** autorelease bile duct supporter fell off naturally and arrived in colon nearly 10 d after the *** 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 *** cases of mortality,hemorrhage,delayed perforation,pancreatitis,cholangitis or duct stenosis with the conventional medical treatment were *** autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon 10 d after the *** autorelease bile duct supporter was successfully removed using forceps or snare under *** recurrence was identified during the 8-mo(ranging from 6-9 mo)follow-up *** In brief,it was found that the autorelease bile duct supporter could decrease the frequency of procedure-associated complications without second endoscopic *** closure of the resection wound

关键词： endoscopic papillectomy Duodenal papilla Bile duct stent Adverse events endoscopic retrograde cholangiopancreatography

Clinical outcomes of endoscopic papillectomy of ampullary adenoma: A multi-center study

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World Journal of Gastroenterology 2022年第17期28卷 1845-1859页

作者： Seong Ji Choi Hong Sik Lee Jiyeong Kim Jung Wan Choe Jae Min Lee Jong Jin Hyun Jai Hoon Yoon Hyo Jung Kim Jae Seon Kim Ho Soon Choi Department of Internal Medicine Hanyang University College of MedicineSeoul 04763South Korea Division of Gastroenterology and Hepatology Department of Internal MedicineKorea University College of MedicineSeoul 02841South Korea Lab of Biostatistical Consulting and Research Medical Research Collaborating CenterIndustry-University Cooperation FoundationHanyang UniversitySeoul 04763South Korea

BACKGROUND Ampullary adenoma is a rare premalignant lesion,but its incidence is *** papillectomy has become the first treatment of choice for ampullary adenomas due to its safety and effectiveness,thereby replacing surgical ***,recurrence rates and adverse events after endoscopic papillectomy were reported in up to 30%of *** To review the long-term outcomes of endoscopic papillectomy and investigate the factors that affect these *** We retrospectively analyzed the data of patients who underwent endoscopic papillectomy for ampullary adenoma at five tertiary hospitals between 2013 and *** evaluated clinical outcomes and their risk *** definitions of outcomes were as follow:(1)curative resection:complete endoscopic resection without recurrence;(2)endoscopic success:treatment of ampullary adenoma with endoscopy without surgical intervention;(3)early recurrence:reconfirmed adenoma at the first endoscopic surveillance;and(4)late recurrence:reconfirmed adenoma after the first endoscopic *** A total of 106 patients were included for *** the included patients,81(76.4%)underwent curative resection,99(93.4%)had endoscopic success,showing that most patients with noncurative resection were successfully managed with *** patients(15.1%)had piecemeal resection,22 patients(20.8%)had shown positive/uncertain resection margin,11 patients(16.1%)had an early recurrence,13 patients(10.4%)had a late recurrence,and 6 patients(5.7%)had a *** multivariate analysis,a positive/uncertain margin[Odds ratio(OR)=4.023,P=0.048]and piecemeal resection(OR=6.610,P=0.005)were significant risk factors for early and late recurrence,*** resection was also a significant risk factor for non-curative resection(OR=5.424,P=0.007).Twenty-six patients experienced adverse events(24.5%).CONCLUSION endoscopic papillectomy is a safe and effective treatment for ampullary ***

关键词： endoscopic papillectomy Ampullary adenoma Clinical outcome Recurrence Adverse event

Bleeding after endoscopic papillectomy and its risk factors:A single center experience of 196 cases

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Hepatobiliary & Pancreatic Diseases International 2024年第6期23卷 613-619页

作者： Jin Ho Choi Won Chul Kim Joo Kyung Park Jong Kyun Lee Kyu Taek Lee Kwang Hyuck Lee Department of Medicine Division of GastroenterologySamsung Medical CenterSungkyunkwan University School of MedicineSeoul 06351Korea

Background:endoscopic papillectomy(EP)is an effective method to remove an ampulla of Vater(AoV)adenoma with minimal *** reviewed the clinical outcomes and prognosis of patients undergoing EP,including tumor recurrence and adverse ***:A total of 196 patients who underwent EP from January 2004 to December 2017 were *** information was collected through electronic medical records,and risk factors to predict postprocedural bleeding were analyzed using a multivariate logistic regression ***:A total of 93.9%patients(184/196)underwent complete *** the follow-up period,14.7%patients(27/184)experienced tumor recurrence,and two of seven surgically resected tumors were malignant.A total of 45.4%patients(89/196)experienced adverse events related to *** bleeding occurred in 16.3%of the patients(32/196),and they were all successfully treated with endoscopic hemostasis and conservative *** most frequent site of delayed bleeding was the distal end of the papillary orifice,and 56.3%(18/32)patients of delayed bleeding were classified as having mild severity,the others had moderate *** adenomatous polyposis(FAP)[odds ratio(OR)=3.80,95%confidence interval(CI):1.01-14.29;P<0.05]and male sex(OR=2.82,95%CI:1.04-7.63;P=0.04)showed statistical significance in predicting delayed post-EP ***:EP for AoV adenoma was a highly effective and safe *** risk of post-EP delayed bleeding was increased in patients with FAP syndrome and male patients,and post-EP bleeding occurred most commonly in the distal part of the AoV.

关键词： Ampullary neoplasm endoscopic papillectomy Post-procedural bleeding Risk factor

endoscopic papillectomy: The limits of the indication, technique and results

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World Journal of Gastrointestinal Endoscopy 2015年第10期7卷 987-994页

作者： Jose Celso Ardengh Rafael Kemp Eder Rios Lima-Filho Jose Sebastiao dos Santos Division of Digestive and endoscopic Surgery Department of Surgery and Anatomy Ribeirao Preto School of Medicine University of Sao Paulo Department of Surgery Hospital Federal dos Servidores do Estado Rua Sacadura Cabral Rio de Janeiro 20221-903 Brazil

In the majority of cases, duodenal papillary tumors are adenomas or adenocarcinomas, but the endoscopy biopsy shows low accuracy to make the correct differentiation. endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are important tools for the diagnosis, staging and management of ampullary lesions. Although the endoscopic papillectomy(EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The authors review the epidemiology and discuss the current evidence for the use of endoscopic procedures for resection, the selection of the patient and the preventive maneuvers that can minimize the probability of persistent or recurrent lesions and to avoid complications after the procedure. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas.

关键词： Epidemiology Ampullary tumors Endo-scopic resection endoscopic ultrasound Staging endoscopic papillectomy Surgical ampullectomy

Impact of pancreatic and biliary stent on post-endoscopic papillectomy complications:A single-center retrospective study

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Chinese Medical Journal 2024年第17期137卷 2111-2118页

作者： Nan Ru Ningli Chai Bo Zhang Longsong Li Yawei Bi Enqiang Linghu Department of Gastroenterology The First Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100853China Digestive Endoscopy Center The First Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100853China

Background:endoscopic papillectomy(EP)is recommended as the first-line therapy for ampullary tumors,despite a relatively high incidence of *** and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP *** present study aimed to evaluate the efficacy of different ***:A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the *** patients were divided into a pancreatic stent group(PS group,n=47),a biliary stent group(BS group,n=38),and a two-stent group(PBS[PS and BS]group,n=32).Relevant clinical data were collected and compared among the three *** logistic analyses were performed to explore risk factors for post-EP ***:The incidence of all complications was 37.6%(44/117).Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5%(17/117)and 17.9%(21/117).The incidence rates of post-EP pancreatitis were 10.6%(5/47),23.7%(9/38),and 9.4%(3/32)in the PS group,BS group,and PBS group,respectively,with no significant *** were also no significant differences in other complications among the three ***(odds ratio[OR]:0.95;95%confidence interval[CI]:0.91-0.99;P=0.022)was independently associated with post-EP pancreatitis while tumor size(OR:1.66;95%CI:1.06-2.60;P=0.028)was independently associated with post-EP ***:While pancreatic stenting is the first choice to prevent post-EP pancreatitis,biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic ***-stent(biliary and pancreatic stent)placement is unnecessary unless it is required due to other concerns.

关键词： endoscopic papillectomy Complications Preventive measures Pancreatitis Hemorrhage

Microscopic transduodenal excision of an ampullary adenoma:A case report and review of the literature

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World Journal of Clinical Cases 2021年第18期9卷 4844-4851页

作者： Xiang Zheng Qing-Jing Sun Bo Zhou Ming Jin Sheng Yan Department of General Surgery The Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009Zhejiang ProvinceChina The Affiliated Hospital of Stomatology School of StomatologyZhejiang University School of Medicineand Key Laboratory of Oral Biomedical Research of Zhejiang ProvinceHangzhou 310006Zhejiang ProvinceChina

BACKGROUND Transduodenal local excision is an alternative treatment approach for benign ampullary ***,this procedure has technical difficulties,especially during reconstruction of the pancreaticobiliary *** operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification,illumination,and stereoscopic *** application of an operating microscope in transduodenal excision of ampullary tumors has not been *** SUMMARY A 55-year-old woman was admitted for investigation of recurrent upper abdominal *** examination and laboratory tests found no *** identified a large mass in the descending part of the *** revealed a 3.5-cm-sized villous growth over the major duodenal *** of the endoscopic biopsy indicated a villous adenoma with low-grade *** transduodenal excision of the ampullary tumor was *** final pathological diagnosis was villous-tubular adenoma with low-grade *** patient was discharged on postoperative day 12 after an uneventful *** retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor *** patient is continuing follow-up at our clinic and remains *** Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.

关键词： Operating microscope Transduodenal local excision Ampullary tumor endoscopic papillectomy Pancreaticoduodenectomy Case report