A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma - 20/04/17
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
Esquema
DISCLOSURE: This work was partly supported by the Soonchunhyang University Research Fund. All authors disclosed no financial relationships relevant to this publication. |
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See CME section; p. 829. |
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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. |
Vol 85 - N° 4
P. 746-755 - avril 2017 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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