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Lee J, Park YB, Han SY, Joo DC, Hong SM, Yi K, Kim DU. New Method of Papillectomy May Decrease Recurrence: Anchoring Method versus Conventional Method. J Clin Med 2024; 13:3226. [PMID: 38892937 PMCID: PMC11172506 DOI: 10.3390/jcm13113226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Endoscopic papillectomy (EP) is the preferred treatment for ampullary tumors because it has fewer side effects than surgical removal. This study retrospectively compared a new anchoring EP method (A-EP) with the conventional (C-EP) approach. Methods: Ninety-nine patients who underwent EP at a single medical institution between 2009 and 2021 were retrospectively reviewed. In all patients, the indications for EP were pathological adenoma with <10 mm of biliary invasion and a tumor diameter <30 mm on endoscopic ultrasonography. The exclusion criteria were antiplatelet/anticoagulant use, previous upper GI surgery, or prior biliary/pancreatic endoscopic therapy. One expert endoscopist performed the two types of EPs, A-EP and C-EP. Results: Sixty-two patients underwent A-EP, and 37 underwent C-EP. There were no significant differences in baseline characteristics, such as sex, age, tumor size, and ductal invasion on endoscopic ultrasound. The A-EP group had higher en bloc resection rates (95.2% vs. 78.4%, p = 0.010). Although the difference was not statistically significant, it tended towards fewer incidences of pancreatitis (p = 0.081) and duct stricture (p = 0.081). The recurrence rate was lower in the A-EP group (8.1% vs. 37.8%, p = 0.000). There were no significant differences between the two groups regarding the follow-up period (A-EP vs. C-EP, 725 vs. 1045 days, p = 0.109) or the days of recurrence (A-EP vs. C-EP, 341 vs. 562 days, p = 0.551). Conclusions: A-EP showed better outcomes than C-EP in terms of en bloc resection and recurrence rates, providing evidence for the efficacy of this novel EP method.
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Affiliation(s)
- Jonghyun Lee
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Yong Bo Park
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
| | - Sung Yong Han
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Dong Chan Joo
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Seung Min Hong
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Kiyoun Yi
- Division of Gastroenterology, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea; (J.L.); (Y.B.P.); (S.Y.H.); (D.C.J.); (S.M.H.); (K.Y.)
- Department of Internal Medicine, College of Medicine, Pusan National University, Yangsan 50612, Republic of Korea
| | - Dong Uk Kim
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi-si 39295, Republic of Korea
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Ru N, Chai N, Zhang B, Li L, Bi Y, Linghu E. Impact of pancreatic and biliary stent on post-endoscopic papillectomy complications: A single-center retrospective study. Chin Med J (Engl) 2024:00029330-990000000-01081. [PMID: 38809090 DOI: 10.1097/cm9.0000000000002893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Endoscopic papillectomy (EP) is recommended as the first-line therapy for ampullary tumors, despite a relatively high incidence of complications. Pancreatic and/or biliary stents are placed at the endoscopist's discretion to prevent post-EP complications. The present study aimed to evaluate the efficacy of different stents. METHODS A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study. These 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 groups. Multivariate logistic analyses were performed to explore risk factors for post-EP complications. RESULTS 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 differences. There were also no significant differences in other complications among the three groups. Age (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 hemorrhage. CONCLUSIONS 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 cannulation. Two-stent (biliary and pancreatic stent) placement is unnecessary unless it is required due to other concerns.
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Affiliation(s)
- Nan Ru
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ningli Chai
- Digestive Endoscopy Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Bo Zhang
- Digestive Endoscopy Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yawei Bi
- Digestive Endoscopy Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Xie J, Hong D, Jiang C, Chen L, Li D, Wang W. The usefulness of traction-assisted endoscopic papillectomy for ampullary early tumors(with video). Scand J Gastroenterol 2024; 59:489-495. [PMID: 38095567 DOI: 10.1080/00365521.2023.2289353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/25/2023] [Indexed: 04/04/2024]
Abstract
Objective Endoscopic papillectomy(EP) is a minimally invasive treatment for early ampullary tumors. However, the optimal method is unclear. The aim of this study is to explore the efficacy and safety of traction-assisted EP treatments for ampullary early tumors.Methods We retrospective analyzed the patients with ampullary adenoma or early adenocarcinoma underwent endoscopic papillectomy between January 2010 and August 2023, including patient characteristics, lesion size, papilla type, pathological diagnosis and lesion surrounding conditions, en-bloc resection rate, complete resection rate, procedure time, complications, recurrences.Results During the study period, a total of 106 patients with ampullary adenoma or early adenocarcinoma underwent EP. The number of patients in traction group (clip combined with dental floss traction, CDT-EP) and non-traction group (hot snare papillectomy, HSP or endoscopic mucosal resection, EMR) were 45 and 61 respectively. The traction group has a higher en-bloc resection rate and complete resection rate than the non-traction group (92.86% vs. 68.85%, p = 0.003; 90.48% vs. 60.66%, p = 0.001), and the procedure time is slightly shorter[(1.57 ± 1.93)min vs. (1.98 ± 1.76)min, p = 0.039]. The complications and recurrence in the traction group were lower than those in the non-traction group (7.14% vs. 19.72%, p = 0.076; 7.14% vs. 11.78%, p = 0.466), and all complications were successfully treated by endoscopy or conservative medical treatment. There was no statistical difference between the two groups in terms of patient characteristics, papilla type, pathological diagnosis and lesion surrounding conditions (p > 0.050), but there were differences in lesion size[(13 ± 1.09)mm vs. (11 ± 1.65)mm, p = 0.002]. The recurrence rate of the traction group is lower than that of the non-traction group, but the difference is not significant(7.14% vs. 13.11%, p = 0.335), and the non-traction group mainly has early recurrence. Further analysis shows that the size of the lesion, whether en-bloc resection or not, and the method of resection as independent risk factors for incomplete resection (OR = 1.732, p = 0.031; OR = 3.716, p = 0.049; OR = 2.120, p = 0.027).Conclusions CDT- EP, HSP and EMR are all suitable methods for the treatment of ampullary adenoma or early adenocarcinoma. Assisted traction technology can reduce the operation difficulty of large and difficult to expose lesions, thereby improving the efficacy and safety of EP.
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Affiliation(s)
- Jiao Xie
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
| | - Donggui Hong
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
| | - Chuanshen Jiang
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
| | - Longping Chen
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
| | - Dazhou Li
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
| | - Wen Wang
- Department of Digestive Diseases, 900th Hospital of PLA, Fuzhou, China
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Li CJ, Chang TE, Hou MC, Huang YH, Lee PC, Chang NW, Chen YJ, Lee FY. Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study. J Chin Med Assoc 2023; 86:147-154. [PMID: 36534757 PMCID: PMC9847683 DOI: 10.1097/jcma.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019, known as a widespread, aerosol spreading disease, has affected >549 000 000 people since 2019. During the lockdown period, dramatic reduction of elective endoscopic procedures, including endoscopic retrograde cholangiopancreatography, had been reported worldwide, leading to delayed diagnosis and treatment. Nevertheless, whether patients' hospital stays and complication rate of endoscopic retrograde cholangiopancreatography (ERCP) during the lockdown period were influenced by the pandemic still remains controversial. METHODS Patients who diagnosed with obstructive jaundice and acute cholangitis in the lockdown period, May 16 to July 26, 2021, were compared to the same prepandemic period in 2019. RESULTS A total of 204 patients in 2019 and 168 patients in 2021 were diagnosed with acute biliary cholangitis or obstructive jaundice, and 82 of the patients in 2019 and 77 patients in 2021 underwent ERCP ( p = 0.274). Patients whose quick Sequential Organ Failure Assessment (qSOFA) score was ≥ 2 occurred more during the lockdown period than during the normal period (24/77, 31.1% vs 12/82, 14.6%; p = 0.013). The initial laboratory data, including, total bilirubin (4.12 in 2021 vs 3.08 mg/dL in 2019; p = 0.014), gamma-glutamyl transferase (378 in 2021 vs 261 U/L in 2019; p = 0.009), and alkaline phosphatase (254 in 2021 vs 174 U/L in 2019; p = 0.002) were higher during the lockdown period compared to 2019. Hospital stay was statistically significant longer in the lockdown period (11 days [7.00-22.00] in 2021 vs 8 days in 2019 [6.00-12.00]; p value = 0.02). Multivariate analysis showed that qSOFA ≥ 2 (hazard ratio [HR] = 3.837, 95% confidence interval [CI] = 1.471-10.003; p = 0.006), and malignant etiology (HR = 2.932, 95% CI = 1.271-6.765; p = 0.012) were the statistically significant factors for a prolonged hospital stay, which was defined as hospital stay >21 days. ERCP-related complications and mortality rate were not statistically different between the two periods. CONCLUSION Patients from May 16 to July 26, 2021, the lockdown period, had longer hospital stays and higher biliary tract enzyme levels, which indicated more severe disease. Nevertheless, ERCP could be safely and successfully performed even during the medical level 3 alert lockdown period without causing an increase in procedure-related complications and mortality.
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Affiliation(s)
- Chia-Ju Li
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tien-En Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Fa-Yuah Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Miyano A, Ogura T, Nishikawa H. Noninvasive endoscopic hemostasis technique for post-papillectomy bleeding using a novel self-assembling peptide (with video). JGH Open 2022; 7:81-82. [PMID: 36660055 PMCID: PMC9840193 DOI: 10.1002/jgh3.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
Although a novel hemostatic agent has been used for endoscopic mucosal resection in submucosal dissection, there are few case reports of its use in pancreato-biliary endoscopic procedures. We describe a case of post-endoscopic papillectomy bleeding in which endoscopic hemostasis was achieved using a novel hemostatic agent.
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Affiliation(s)
- Akira Miyano
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Takeshi Ogura
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Hiroki Nishikawa
- 2nd Department of Internal MedicineOsaka Medical and Pharmaceutical UniversityOsakaJapan
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