Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2020; 26(40): 6250-6259
Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6250
Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
Lei Jiang, En-Qiang Ling-Hu, Ning-Li Chai, Wen Li, Feng-Chun Cai, Ming-Yang Li, Xu Guo, Jiang-Yun Meng, Xiang-Dong Wang, Ping Tang, Jing Zhu, Hong Du, Hong-Bin Wang
Lei Jiang, En-Qiang Ling-Hu, Ning-Li Chai, School of Medicine, Nankai University, Tianjin 300071, China
En-Qiang Ling-Hu, Ning-Li Chai, Wen Li, Feng-Chun Cai, Ming-Yang Li, Xu Guo, Jiang-Yun Meng, Xiang-Dong Wang, Ping Tang, Jing Zhu, Hong Du, Hong-Bin Wang, Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Author contributions: Ling-Hu EQ contributed to study conception and design; Jiang L, Ling-Hu EQ, and Chai NL should be considered as joint first authors; Ling-Hu EQ, Chai NL, Li W, Cai FC, Li MY, and Guo X performed the operations; Meng JY, Wang XD, Tang P, Zhu J, Du H, and Wang HB assisted in operations; Jiang L contributed to data acquisition, analysis, and interpretation and drafted the manuscript; Ling-Hu EQ critically revised the article for important intellectual content; all authors read and approved the manuscript.
Supported by National Key R and D Program of China, No. 2016YFC1303601.
Institutional review board statement: No specific IRB approval was required for this study according to the Ethics Committee of Chinese PLA General Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Nothing to disclose.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: En-Qiang Ling-Hu, MD, PhD, Chief Doctor, Chief Physician, Director, Professor, Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. linghuenqiang@vip.sina.com
Received: May 14, 2020
Peer-review started: May 14, 2020
First decision: May 21, 2020
Revised: September 4, 2020
Accepted: September 17, 2020
Article in press: September 17, 2020
Published online: October 28, 2020
Abstract
BACKGROUND

Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. Endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical adverse events that restrict its wider use. There is no standard procedure for endoscopic papillectomy yet. The procedure is relevant to postoperative adverse events.

AIM

To reduce the postoperative adverse event rates and improve patients’ postoperative condition, we developed a standard novel procedure for endoscopic papillectomy.

METHODS

The novel endoscopic papillectomy had two main modifications based on the conventional method: The isolation of bile from pancreatic juice with a bile duct stent and wound surface protection with metal clips and fibrin glue. We performed a single-center retrospective comparison study on the novel and conventional methods to examine the feasibility of the novel method for reducing postoperative adverse events.

RESULTS

A total of 76 patients, of whom 23 underwent the novel procedure and 53 underwent the conventional procedure, were retrospectively evaluated in this study. The postoperative bleeding and pancreatitis rates of the novel method were significantly lower than those of the conventional method (0 vs 20.75%, P = 0.028, and 17.4% vs 41.5%, P = 0.042, respectively). After applying the novel method, the most critical adverse event, perforation, was entirely prevented, compared to a prevalence of 5.66% with the conventional method. Several postoperative symptoms, including fever, rapid pulse, and decrease in hemoglobin level, were significantly less frequent in the novel group (P = 0.042, 0.049, and 0.014, respectively). Overall, the total adverse event rate of the novel method was lower (0 vs 24.5%, P = 0.007) than that of the conventional method.

CONCLUSION

Patients who underwent the novel procedure had lower postoperative adverse event rates. This study demonstrates the potential efficacy and safety of the novel endoscopic papillectomy in reducing postoperative adverse events.

Keywords: Endoscopic papillectomy, Novel technique, Adverse events, Papillary adenoma, Endoscopic retrograde cholangiopancreatography, Bile duct stent

Core Tip: The novel method of endoscopic papillectomy mainly includes two modifications: Isolating bile from pancreatic juice with a bile duct stent and closing the wound surface with metal clips and fibrin glue. Our retrospective comparison showed that postoperative adverse events, including bleeding, pancreatitis, and overall adverse events, were less frequent in the novel endoscopic papillectomy group than in the conventional endoscopic papillectomy group. Postoperative perforation was entirely prevented by this novel method. This study demonstrates that novel endoscopic papillectomy is a potentially effective and safe method for reducing postoperative adverse events.