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A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma - 20/04/17

Doi : 10.1016/j.gie.2016.08.013 
Jong Jin Hyun, MD, PhD 1, Tae Hoon Lee, MD, PhD 2, , Jin-Seok Park, MD 3, Joung-Ho Han, MD, PhD 4, Seok Jeong, MD, PhD 3, Seon Mee Park, MD, PhD 4, Hong Sik Lee, MD, PhD 1, Jong Ho Moon, MD, PhD 5, Sang-Heum Park, MD, PhD 2
1 Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea 
2 Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, Korea 
3 Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea 
4 Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea 
5 Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea 

Reprint requests: Tae Hoon Lee, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan-si, Chungcheongnam-do, 330-721, Korea.Division of GastroenterologyDepartment of Internal MedicineSoonchunhyang University School of MedicineCheonan Hospital23-20 Bongmyung-dong, Cheonan-siChungcheongnam-do, 330-721Korea

Abstract

Background and Aims

Whether or not submucosal injection of a diluted epinephrine solution should be used to lift ampullary tumors during endoscopic snare papillectomy is unclear. This study aimed to investigate the clinical efficacy of a simple snaring method versus submucosal injection for papillectomy.

Methods

A prospective multicenter study was performed at 4 tertiary referral centers. Patients with papillary lesions were randomized to undergo either simple snare papillectomy (SSP) or submucosal injection papillectomy (SIP) using 1:10,000 diluted epinephrine. The main outcome measures were complete resection rate and post-papillectomy adverse events.

Results

A total of 50 patients with biopsy-proven papillary adenomas were enrolled. Complete resection rates in the SSP and SIP groups were 80.8% (21/26) and 50.0% (12/24), respectively (P = .02). However, tumor persistence at 1 month (15.4% vs 8.3%, P = .62) and recurrence at 12 months (12.0% vs 9.5%, P = .58) did not differ despite initial differences in the prevalence of a positive resection margin. The mean tumor size was 12 mm in the SSP group and 9.29 mm in the SIP group. Post-papillectomy bleeding developed in 42.3% (11/26) and 45.8% (11/24) of patients, respectively (P = .80). Delayed bleeding (>12 h) occurred in 27.3% (3/11) and 36.4% (4/11) of patients, respectively (P = .50). Post-procedure pancreatitis occurred in 15.4% (4/26) and 25% (6/24) of patients, respectively (P = .49). Pancreatitis severity did not differ between the groups, and there were no procedure-related mortalities.

Conclusions

Although the recurrence rate was similar between the SSP and SIP groups, SIP showed no advantage over SSP in terms of achieving complete resection or decreasing the frequency of post-papillectomy adverse events, such as bleeding. SSP may thus be a simpler and primarily recommendable technique. (Clinical trial registration number: NCT02165852.)

El texto completo de este artículo está disponible en PDF.

Abbreviations : AoV, APC, SSP, SIP


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 DISCLOSURE: This work was partly supported by the Soonchunhyang University Research Fund. All authors disclosed no financial relationships relevant to this publication.
 See CME section; p. 829.
 If you would like to chat with an author of this article, you may contact Dr Lee at thlee9@schmc.ac.kr or taewoolee9@gmail.com.


© 2017  American Society for Gastrointestinal Endoscopy. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 85 - N° 4

P. 746-755 - avril 2017 Regresar al número
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