Outcomes of Endoscopic Papillectomy After an Insulated Plastic Pancreatic Stent Placement: A Retrospective Cohort Study

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology Pub Date : 2025-05-13 DOI:10.1111/jgh.16996

Chang-Young Choi, Sun Ung Youn, Ji Min Kim, Jae Chul Hwang, Byung Moo Yoo, Soon Sun Kim, Jin Hong Kim, Min Jae Yang

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引用次数: 0

Abstract

Background and Aim

Insulated plastic pancreatic stent placement before endoscopic papillectomy (EP) was introduced to prevent post-EP pancreatic stenting difficulties, avoid stent transection during EP, and ensure a safe hemostatic procedure in cases of post-EP bleeding by securing the pancreatic orifice. This study aimed to evaluate the technical efficacy and long-term outcomes of this procedure.

Methods

A retrospective analysis of 84 patients who underwent EP for ampullary adenomas between August 2006 and December 2020 was conducted using a 5-Fr polytetrafluoroethylene (PTFE)-insulated handmade pancreatic stent.

Results

EP after pancreatic stenting was successfully performed in 73/84 patients (86.9%). En bloc resection was performed in 59/73 patients (80.8%), and complete resection was achieved in 63/73 patients (86.3%). No stent transection was observed. Delayed bleeding was encountered in seven (9.6%) and 24 (32.9%) patients based on consensus guidelines and extended definitions, respectively. The incidence of pancreatitis was less frequent in the pre-EP pancreatic stenting group than in the post-EP pancreatic stenting group but statistically nonsignificant and underpowered (6.8 vs. 18.2%; p = 0.227, 95% confidence interval 0.046–4.030). In complete resection cases, tumor recurrence was encountered in six patients (8.2%) with surveillance for a median of 24 months. In the long term, one case (1.4%) of cholangitis and four cases (5.5%) of papillary structures developed.

Conclusions

Insulated PTFE plastic stent placement before EP may serve as an alternative to conventional EP, considering the feasibility of pancreatic stent placement, en bloc resectability, incidence of post-EP pancreatitis, and long-term oncological prognosis.

查看原文本刊更多论文

置入绝缘塑料胰腺支架后内镜乳头切除术的结果：一项回顾性队列研究。

背景和目的：在内镜乳头切除术（EP）前放置绝缘塑料胰腺支架，以防止EP后胰腺支架置入困难，避免EP期间支架横断，并通过固定胰腺口确保EP后出血的安全止血手术。本研究旨在评估该手术的技术疗效和长期结果。方法：回顾性分析2006年8月至2020年12月期间84例因壶腹腺瘤接受EP治疗的患者，使用5-Fr聚四氟乙烯（PTFE）绝缘手工胰腺支架。结果：73/84例（86.9%）患者成功行胰内支架植入术。整体切除59/73例（80.8%），完全切除63/73例（86.3%）。未观察到支架断裂。根据共识指南和扩展定义，分别有7例（9.6%）和24例（32.9%）患者出现延迟出血。胰腺炎的发生率在ep前胰支架置入组低于ep后胰支架置入组，但无统计学意义且动力不足(6.8 vs 18.2%；P = 0.227, 95%置信区间为0.046-4.030)。在完全切除的病例中，6例患者（8.2%）出现肿瘤复发，随访时间中位数为24个月。长期观察，胆管炎1例（1.4%），乳头状结构4例（5.5%）。结论：考虑胰腺支架置入的可行性、整体可切除性、EP后胰腺炎的发生率以及长期肿瘤预后，在EP前置入绝缘聚四氟乙烯塑料支架可作为常规EP的替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.40%

发文量

326

审稿时长

2.3 months

期刊介绍： Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.