Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the...Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the safety of endoscopic papillectomy with a guidewire and pancreatic-duct stent insertion to prevent pa ncreatitis. Methods: Six patients were enrolled. The snare loop was passed over a guidewire that had been inserted into the pancreatic duct. Immediately after s nare resection, a pancreatic stent was placed along the indwelling guidewire. Re sults:En bloc papillectomy and pancreatic stent insertion were performed successfully in all patients. Pancreatitis did not develop acutely in any pati ent. Complications included cholangitis (n= 1) and late-onset pancreatitis owin g to the pancreatic stent(n = 1). Scant residual adenomatous tissue was present at resection margins in two patients and was treated endoscopically.Conclusions: Wire-guided endoscopic snare papillectomy in selected patients is a useful tec hnique that maintains pancreatic-duct access for stent placement. This appears to prevent pancreatitis and to improve the outcome for patients undergoing endos copic resection of papillary tumors.展开更多
文摘Background: Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a ser ious drawback. This study assessed the feasibility and the safety of endoscopic papillectomy with a guidewire and pancreatic-duct stent insertion to prevent pa ncreatitis. Methods: Six patients were enrolled. The snare loop was passed over a guidewire that had been inserted into the pancreatic duct. Immediately after s nare resection, a pancreatic stent was placed along the indwelling guidewire. Re sults:En bloc papillectomy and pancreatic stent insertion were performed successfully in all patients. Pancreatitis did not develop acutely in any pati ent. Complications included cholangitis (n= 1) and late-onset pancreatitis owin g to the pancreatic stent(n = 1). Scant residual adenomatous tissue was present at resection margins in two patients and was treated endoscopically.Conclusions: Wire-guided endoscopic snare papillectomy in selected patients is a useful tec hnique that maintains pancreatic-duct access for stent placement. This appears to prevent pancreatitis and to improve the outcome for patients undergoing endos copic resection of papillary tumors.
