Clinical Endoscopy

Original Article

Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors: Naoki Okano, Yoshinori Igarashi, Ken Ito, Saori Mizutani, Hiroki Nakagawa, Kouji Watanabe, Yuuto Yamada, Kensuke Yoshimoto, Yuusuke Kimura, Susumu Iwasaki, Kensuke Takuma, Seiichi Hara, Yuui Kishimoto; Clin Endosc 2021;54(5):706-712. Published online March 10, 2021; DOI: https://doi.org/10.5946/ce.2020.208

Background
/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Citations

Citations to this article as recorded by

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Gastrointestinal Endoscopy.2024; 99(4): 587. CrossRef
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Clinical Endoscopy.2021; 54(5): 627. CrossRef

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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases

Recent Advances in Endoscopic Papillectomy for Ampulla of Vater Tumors: Endoscopic Ultrasonography, Intraductal Ultrasonography, and Pancreatic Stent Placement: Jimin Han, Dong Wook Lee, Ho Gak Kim; Clin Endosc 2015;48(1):24-30. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.24

Abstract PDF PubReader ePub

Since it was first described nearly three decades ago, endoscopic papillectomy (EP) has been utilized as a less invasive, alternative therapy for adenoma of the major duodenal papilla. In this article, we review the recent advances in EP, especially those pertaining to endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and pancreatic stent placement for the prevention of postpapillectomy pancreatitis. Because EUS and IDUS have similar diagnostic accuracies, either modality can be used for the preprocedural evaluation of ampullary tumors. Nevertheless, further technical refinements are required for a more precise evaluation. Given the paucity of data on the usefulness of EUS and/or IDUS during follow-up after EP, a well-designed study is warranted. Furthermore, pancreatic stent placement appears to have a protective effect against postpapillectomy pancreatitis; however, a prospective, randomized, controlled study with a larger number of patients is needed to assess this finding. Moreover, since pancreatic stent placement after EP is not always successful, various novel techniques have been developed to ensure reliable stent placement. Despite the recent advances in EP, further technical refinements and studies are needed to confirm their efficacy.

Citations

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The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef
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148 Download
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