Impact of a Thinner Snare Wire With Optimal Electrosurgical Unit Settings on the Risk of Delayed Bleeding After Endoscopic Papillectomy: A Propensity Score-Matched Analysis (With Video).

Abstract

Objectives: The indications for endoscopic papillectomy (EP) have expanded. However, post-procedural adverse events remain high. We performed ex vivo and clinical studies to determine the usefulness of a thinner snare wire (TSW) for preventing delayed bleeding after EP.

Methods: To verify the effect of current flow in the monopolar device, a model of an ampulla lesion was created and then resected using a snare. To examine the coagulation effects produced by varying snare wire diameters, patients who underwent EP for ampullary neoplasms were retrospectively analyzed according to the snare wire diameter in the TSW group and the conventional snare wire (CSW) group. The outcomes were compared after propensity score matching (PSM) to control for selection bias and lack of randomization.

Results: In the ex vivo study, thermal denaturation was found to be stronger on the counter electrode plate side. In the clinical study, 102 patients who underwent EP were included (TSW group, n = 52; CSW group, n = 50). The matched cohorts included 29 patients per group. Delayed bleeding was significantly less frequent in the TSW group than in the CSW group after PSM (3.4% vs. 31%; p = 0.012). Although residual lesions tended to be more frequent in the TSW group (p = 0.053), there were no significant differences in other procedural and pathological outcomes.

Conclusions: The coagulation effect produced by current flow cannot be ignored. Using a TSW may decrease the incidence of delayed bleeding. It is important to select both a suitable snare wire diameter and appropriate electrosurgical unit settings.