Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma
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Outcome of a novel modified endoscopic papillectomy for duodenal major papilla adenoma Pin Wang1 · Chengfei Jiang2 · Yi Wang1 · Lin Zhou1 · Shu Zhang1 · Xiwei Ding1 · Ying lv1 · Lei Wang1 · Xiaoping Zou1 Received: 13 December 2019 / Accepted: 9 June 2020 © The Author(s) 2020
Abstract Background and aims In recent years, with the development of endoscopic techniques, endoscopic resection is widely used for duodenal papillary adenomas, but conventional endoscopic resection has a high rate of incomplete resection and recurrence. On this basis, we have employed a novel modified endoscopic papillectomy (ESP). In this study, we evaluated the feasibility and advantages of this ESP for the treatment of duodenal major papilla adenoma. Methods A total of 56 patients with duodenal major papilla adenoma confirmed by endoscopic ultrasonography, intraluminal ultrasound and gastroscopic biopsy from October 2007 to June 2017 were collected in the Department of Gastroenterology, Nanjing Drum Tower Hospital. The diameter of the adenoma ranged from 1.41 to 2.02 cm. 16 cases were given the conventional method and 40 cases underwent the modified ESP procedure in which a small incision was made by cutting current when anchoring the snare tip on the distal side of the adenoma. Results En bloc resection rate was significantly higher in the modified group (100%, 40/40) than that in the conventional group (81.3%, 13/16; P = 0.02). However, no significance was seen between the modified group and the conventional group in complete resection rate (92.5%, 37/40 vs 93.8%, 15/16; P = 1.00). There was no significant difference in the number and difficulty of postoperative pancreatic and biliary stents placement between the two groups (P = 0.20). Total bleeding occurrence was much lower in the modified group (37.5%, 15/40 vs 87.5%, 14/16; P = 0.001), and no significant differences were found in other short-term complications and the 3, 6, 12 and 24 months recurrences rate between the conventional and modified ESP groups. Conclusions The modified ESP improves the treatment outcome of duodenal major papilla adenoma with higher en bloc resection rate and lowering bleeding rate. Keywords Adenoma · Duodenal major papilla · Endoscopic resection · Modified endoscopic papillectomy
Pin Wang and Chengfei Jiang have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07715-0) contains supplementary material, which is available to authorized users. * Lei Wang [email protected] * Xiaoping Zou [email protected] 1
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu, China
Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
2
The duodenal papilla adenomas are part of the tumors of the ampulla of Vater, with the most common ones being ampul
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