Published online Oct 28, 2020. doi: 10.3748/wjg.v26.i40.6250
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
Processing time: 166 Days and 8.7 Hours
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.
To reduce the postoperative adverse event rates and improve patients’ postoperative condition, we developed a standard novel procedure for endoscopic papillectomy.
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.
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.
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.
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.