Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7785-7793
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7785
Prospective single-center feasible study of innovative autorelease bile duct supporter to delay adverse events after endoscopic papillectomy
Sheng-Zhen Liu, Ning-Li Chai, Hui-Kai Li, Xiu-Xue Feng, Ya-Qi Zhai, Nan-Jun Wang, Ying Gao, Fei Gao, Sha-Sha Wang, En-Qiang Linghu
Sheng-Zhen Liu, Ning-Li Chai, Hui-Kai Li, Xiu-Xue Feng, Ya-Qi Zhai, Nan-Jun Wang, Ying Gao, Fei Gao, Sha-Sha Wang, En-Qiang Linghu, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Liu SZ and Chai NL contributed equally to this work; Liu SZ, Chai NL, Li HK, and Linghu EQ designed the study; Liu SZ, Gao F, Feng XX, and Wang SS performed the research; Gao Y and Wang NJ contributed new reagents and analytic tools; Liu SZ and Chai NL analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Supported by National Key R&D Program of China, No. 2016YFC1303600.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chinese PLA General Hospital (Approval No. S2019-108-02).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Qiang Linghu, MD, Chairman, Chief Doctor, Department of Gastroenterology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: March 5, 2022
Peer-review started: March 5, 2022
First decision: April 11, 2022
Revised: April 18, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: August 6, 2022
Abstract
BACKGROUND

Conventional endoscopic papillectomy (EP) is safe and effective for the treatment of small papilla adenoma to even large laterally spreading tumors of duodenum lesions. As reported by some existing studies, temporarily placing a prophylactic stent in the pancreatic and bile duct can lower the risk of this perioperative complication.

AIM

To evaluate the usefulness, convenience, safety, and short-term results of a novel autorelease bile duct supporter after EP procedure, especially the effectiveness in preventing EP.

METHODS

A single-center comparison study was conducted to verify the feasibility of the novel method. After EP, a metallic endoclip and human fibrin sealant kit were applied for protection. The autorelease bile duct supporter fell into the duct segment and the intestinal segment. Specifically, the intestinal segment was extended by nearly 5 cm as a bent coil. The bile was isolated from the pancreatic juice using an autorelease bile duct supporter, which protected the wound surface. The autorelease bile duct supporter fell off naturally and arrived in colon nearly 10 d after the operation.

RESULTS

En bloc endoscopic resection was performed in 6/8 patients (75%), and piecemeal resection was performed in 2/8 of patients (25%). None of the above patients were positive for neoplastic lymph nodes or distant metastasis. No cases of mortality, hemorrhage, delayed perforation, pancreatitis, cholangitis or duct stenosis with the conventional medical treatment were reported. The autorelease bile duct supporter in 7 of 8 patients fell off naturally and arrived in colon 10 d after the operation. One autorelease bile duct supporter was successfully removed using forceps or snare under endoscopy. No recurrence was identified during the 8-mo (ranging from 6-9 mo) follow-up period.

CONCLUSION

In brief, it was found that the autorelease bile duct supporter could decrease the frequency of procedure-associated complications without second endoscopic retraction. Secure closure of the resection wound with clips and fibrin glue were indicated to be promising and important for the use of autorelease bile duct supporters. Well-designed larger-scale comparative studies are required to confirm the findings of this study.

Keywords: Endoscopic papillectomy, Duodenal papilla, Bile duct stent, Adverse events, Endoscopic retrograde cholangiopancreatography

Core Tip: In this study, a novel autorelease bile duct supporter was successfully inserted through a guide wire using endoscopic retrograde cholangiopancreatography in all patients after endoscopic papillectomy, during which an experienced operator was required for the insertion of the guide wire. The novel autorelease bile supporter entered the colon nearly 10 d after the endoscopic procedure with automatic shedding characteristics and decreased the frequency of procedure-related complications without a second endoscopic retraction.