Zhang M, Liu J, Zhou PL, Zhao Q, Yang Z. Clinical outcomes of endoscopic papillectomy: The experience in a Chinese tertiary hospital. World J Gastrointest Surg 2026; 18(9): 122154 [DOI: 10.4240/wjgs.122154]
Corresponding Author of This Article
Zhuo Yang, MD, Chief Physician, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Zhang M, Liu J, Zhou PL, Zhao Q, Yang Z. Clinical outcomes of endoscopic papillectomy: The experience in a Chinese tertiary hospital. World J Gastrointest Surg 2026; 18(9): 122154 [DOI: 10.4240/wjgs.122154]
Meng Zhang, Jiao Liu, Pei-Lin Zhou, Qian Zhao, Zhuo Yang, Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Co-corresponding authors: Qian Zhao and Zhuo Yang.
Author contributions: Zhang M, Liu J, and Yang Z significantly contributed to the conceptualization and design; Zhang M and Zhou PL conducted the literature search and data collection; Zhang M and Liu J conducted the manuscript drafting and they contributed equally to this manuscript as co-first authors; Zhao Q and Yang Z critically revised the article and they contributed equally to this manuscript as co-corresponding authors. All authors approved the final manuscript and agree to be accountable for all aspects of the work.
Supported by Liaoning Provincial Science and Technology Program, No. 2024JH2/102600288.
Institutional review board statement: The study was reviewed and approved by the General Hospital of Northern Theater Command Institutional Review Board [approval No. Y(2025)414].
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: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Zhuo Yang, MD, Chief Physician, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
Received: April 13, 2026 Revised: May 21, 2026 Accepted: June 22, 2026 Published online: September 27, 2026 Processing time: 157 Days and 18.4 Hours
Abstract
BACKGROUND
Endoscopic papillectomy (EP) is the first-line treatment for ampullary neoplasms, however, technical controversies and a substantial risk of adverse events persist. This study aimed to evaluate the clinical outcomes of EP performed according to our standardized protocol, thereby providing evidence to optimize clinical strategies.
AIM
To evaluate the outcomes of a standardized EP protocol and to identify risk factors for postprocedural pancreatitis.
METHODS
In this retrospective study, 76 consecutive patients who underwent EP at a single tertiary center were included. The standardized protocol emphasizes strategic submucosal injection, routine biliary-pancreatic double stenting, and prophylactic clip closure. The primary outcomes included complete resection rates and adverse events. Potential risk factors for post-EP pancreatitis (PEP) were also analyzed.
RESULTS
The complete resection rate was 96.0%. The incidences of PEP and delayed bleeding were 22.4% and 2.6%, respectively. No perforations or procedure-related deaths were observed. Subgroup analyses of submucosal injection, double stenting, or clip closure revealed no statistically significant differences; nevertheless, favorable trends were observed for complete resection, inflammatory complications, and delayed bleeding, respectively. Accordingly, these findings should be considered hypothesis-generating. Univariate analysis identified pre-procedural hypokalemia as the only risk factor for PEP.
CONCLUSION
The standardized EP protocol is effective and safe, and pre-procedural hypokalemia is a modifiable risk factor for PEP.
Core Tip: This single-center study presents a standardized endoscopic papillectomy protocol incorporating submucosal injection, double stenting, and clip closure, achieving high complete resection with a favorable safety profile. A key novel finding is that pre-procedural hypokalemia was identified as an independent, potentially modifiable risk factor for post-endoscopic papillectomy pancreatitis. Subgroup analyses for technical components were underpowered and hypothesis-generating only. Given the rarity of ampullary neoplasms and the difficulty of conducting prospective trials, these real-world insights offer clinically meaningful guidance while higher-level evidence is awaited.
Citation: Zhang M, Liu J, Zhou PL, Zhao Q, Yang Z. Clinical outcomes of endoscopic papillectomy: The experience in a Chinese tertiary hospital. World J Gastrointest Surg 2026; 18(9): 122154
Ampullary neoplasms are uncommon, with a reported prevalence of 0.1%-0.2%[1]. However, their detection rate has increased markedly in recent years[2]. Although histologic types vary and include neuroendocrine tumors and lymphomas, most lesions are duodenal papillary adenomas[3-5], which carry a well-recognized risk of malignant transformation via the adenoma-carcinoma sequence[3], therefore, complete resection is warranted upon diagnosis[6].
Historically, pancreatoduodenectomy was the standard treatment[7,8]; however, its substantial morbidity and mortality[9,10] have stimulated the development of minimally invasive alternatives. Endoscopic papillectomy (EP) has emerged as the preferred modality, conferring lower mortality, shorter hospital stays, and reduced costs compared with surgery[3,11-15].
Despite widespread adoption, EP remains technically challenging and carries substantial risks, notably pancreatitis and delayed bleeding[16]. Furthermore, consensus has not been reached on key technical aspects-including submucosal injection, stenting strategies, and wound management-leading to heterogeneous outcomes.
In this context, high-volume single-center experiences are particularly valuable. We therefore retrospectively analyzed 76 consecutive patients who underwent EP at our tertiary center to assess the efficacy and safety of our standardized technical protocol and to provide real-world evidence for optimizing the endoscopic management of ampullary neoplasms.
MATERIALS AND METHODS
Study design
This single-center, retrospective study was conducted at the Endoscopy Center, General Hospital of Northern Theater Command. Consecutive patients who underwent EP for duodenal papillary neoplasms from January 2019 to October 2024 were enrolled. The study was reviewed and approved by the General Hospital of Northern Theater Command Institutional Review Board [approval No. Y(2025)414] (Figure 1).
Figure 1 Flowchart of the study.
FAP: Familial adenomatous polyposis; PEP: Post-endoscopic papillectomy pancreatitis.
The inclusion criteria were as follows: (1) EP performed for ampullary neoplasm at our institution; (2) Age ≥ 18 years; (3) Duodenal papillary lesion confirmed by gastroscopy or duodenoscopy without endoscopic features of advanced malignancy (ulceration, spontaneous bleeding, or rigidity); (4) Lesion diameter ≤ 4 cm; (5) Preoperative imaging indicating no invasion of the muscularis propria; and (6) No regional lymph node metastasis.
The exclusion criteria were as follows: (1) Prior local therapy (e.g., argon plasma coagulation, radiofrequency ablation); (2) Diagnosis of familial adenomatous polyposis; (3) Pre-procedural biopsy confirming adenocarcinoma; and (4) Resection using non-snare techniques (e.g., nylon loop ligation).
EP procedure
Pre-procedural preparation: Comprehensive evaluations consisted of standard laboratory tests (complete blood count, liver and renal function, coagulation profile) and imaging (chest computed tomography, electrocardiography). Anticoagulant and antiplatelet medications were discontinued according to established guidelines. Local staging was routinely performed using endoscopic ultrasound and abdominal computed tomography to evaluate tumor invasion depth, intraductal extension, and lymph node status. Written informed consent was obtained from all patients.
Intra-procedural technique: Procedures were performed by highly experienced endoscopists (each with more than 10 years of endoscopic retrograde cholangiopancreatography experience) using therapeutic duodenoscopes (Olympus TJF260, TJF240, Tokyo, Japan) under general anesthesia with carbon dioxide (CO2) insufflation.
The procedure was performed as follows: (1) Resection: Submucosal injection of normal saline was performed selectively. A polypectomy snare was used to capture the lesion, aiming to include a 3-5 mm cuff of normal mucosa. Resection was completed using blended high-frequency current. En bloc resection was attempted in all cases; (2) Specimen retrieval and hemostasis: Specimens were retrieved using a snare or basket. The post-resection defect was carefully inspected for bleeding. If needed, adjunctive hemostasis was performed with hot biopsy forceps or diluted epinephrine (1:10000); (3) Biliary and pancreatic stenting: Endoscopic retrograde cholangiopancreatography was routinely performed after resection. Following guidewire cannulation, cholangiopancreatography was obtained, and prophylactic plastic stents were placed in both ducts. Cannulation was aborted after five unsuccessful attempts to minimize trauma, with alternative drainage (nasobiliary/nasopancreatic or percutaneous) considered if necessary; and (4) Wound closure: The mucosal defect was routinely closed with metallic clips (Micro-Tech, ROCC-D-26-195, Nanjing, China). Closure was omitted only in cases of failed stenting or when the defect was very small.
Post-procedural management and follow-up: Serum amylase and lipase levels were measured immediately post-procedure. Management included fasting, proton pump inhibitors, somatostatin analogues, prophylactic antibiotics, and intravenous hydration. Diet was advanced based on clinical recovery. Follow-up endoscopy was scheduled at 1, 3, 6, and 12 months. Stents were removed at the 1-month follow-up visit. During each follow-up, the resection site was carefully inspected for any signs of residual or recurrent disease; biopsies were taken when indicated.
Definitions
Procedure time: Time from the start of resection (defined as initiation of submucosal injection when performed, or snare placement when injection was omitted) to completion of defect closure or stent placement.
Complete resection (R0): Resection (en bloc or piecemeal) with histopathologically negative horizontal and vertical margins.
Post-EP pancreatitis: New or worsened abdominal pain with serum amylase/lipase > 3 times the upper limit of normal. Severity was graded according to the revised Atlanta classification[17].
Residual adenoma: Adenomatous tissue detected within ducts or the resection bed during the initial surveillance endoscopy[18].
Recurrent adenoma: New adenomatous tissue at a previously confirmed R0 site after a negative surveillance endoscopy[18].
Hypokalemia: Serum potassium (K+) < 3.5 mmol/L.
Statistical analysis
Statistical analysis was performed using SPSS 27.0, continuous variables were expressed as mean ± SD or median [interquartile range (IQR)] and compared using the t-test or Wilcoxon rank-sum test, respectively. Categorical data were analyzed using n (%), and compared using the χ2 test or Fisher exact test for analysis. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors for post-EP pancreatitis (PEP). Variables with a P < 0.05 in univariate analysis were included into the multivariate logistic regression model. P < 0.05 was considered statistically significant.
RESULTS
Patient and lesion characteristics
A total of 76 patients were included (mean age 61.2 ± 9.8 years; 58% male). Most lesions (55.2%) were incidental findings. Comorbidities included hypertension, diabetes mellitus, and coronary artery disease; additionally, 10.5% of patients were on long-term anticoagulation. Pre-procedural laboratory values and tumor markers were generally normal. Lesions were predominantly hypoechoic (65.8%) with a median diameter of 15.0 mm (IQR: 15.0-25.0). Significant ductal dilatation was absent [median common bile duct diameter 7.5 mm; pancreatic duct (pancreatoduodenectomy) 2.2 mm)] (Table 1).
Table 1 Baseline characteristics of patients, n (%)/mean ± SD/median (interquartile range).
EP was technically successful in all patients. Submucosal injection was performed in 65/76 (85.5%) patients. En bloc resection was achieved in 69/76 (90.8%). Among patients undergoing en bloc resection, 68/69 (98.6%) achieved R0 margins, whereas 5/7 (71.4%) of piecemeal resections resulted in R0 status. Double stenting and prophylactic clip closure were successfully performed in 64/76 (84.2%) and 67/76 (88.2%) of patients, respectively. The median procedure time was 28.0 minutes (IQR: 18.0-33.8) (Table 2).
Final histopathology showed low-grade dysplasia in 33 (43.4%), high-grade dysplasia in 27 (35.5%), focal carcinoma in 6 (7.9%), adenocarcinoma in 6 (7.9%), and other diagnoses in 4, including neuroendocrine tumor (n = 3) and stromal tumor (n = 1). The R0 resection rate was 96.0%. Adverse events included PEP (22.4%; all graded as mild per the revised Atlanta classification), cholangitis (3.9%), and delayed bleeding (2.6%). No perforation or procedurerelated death occurred. The median follow-up duration was 37 months (IQR: 13-55). During follow-up, residual adenoma was detected in three patients (3.9%), and papillary stenosis in one patient (1.3%) (Table 3).
Table 3 Post-procedural characteristics and follow-up, n (%).
Characteristics
Patients (n = 76)
Pathological
Adenoma with LGIN
33 (43.4)
Adenoma with HGIN
27 (35.5)
Focal carcinoma
6 (7.9)
Carcinoma
6 (7.9)
Others
4 (5.3)
Complete resection
73 (96.0)
Complications
Pancreatitis
17 (22.4)
Cholangitis
3 (3.9)
Bleeding
2 (2.6)
Perforation
0 (0)
Papillary stenosis
1 (1.3)
Length of hospital stay, days, median (interquartile range)
9 (8, 11)
Hospitalization expenses, CNY, median (interquartile range)
30871.4 (27775.1, 38307.4)
Follow-up duration, month, median (interquartile range)
Submucosal injection: Patient demographics, lesion features, and post-procedural outcomes were similar between groups (Supplementary Tables 1-3). The injection group showed favorable trends towards shorter median procedure time, a higher complete resection rate (96.9% vs 90.9%), and lower median hospitalization cost (Table 4).
Table 4 Subgroup analysis of submucosal injection on postoperative outcomes, n (%).
Characteristics
Submucosal injection group (n = 65)
Non-submucosal injection group (n = 11)
P value
Complete resection
63 (96.9)
10 (90.9)
0.379
Complications
Pancreatitis
16 (24.6)
1 (9.1)
0.161
Cholangitis
1 (1.5)
2 (18.2)
0.053
Bleeding
2 (3.1)
0 (0)
1.000
Perforation
0 (0)
0 (0)
1.000
Papillary stenosis
1 (1.5)
0 (0)
1.000
Length of hospital stay, days, median (interquartile range)
9.0 (8.0, 11.0)
9.0 (7.0, 15.0)
0.721
hospitalization expenses, CNY, median (interquartile range)
Double stenting: Comparing the double stenting group with other strategies (single or no stent), patient characteristics were similar (Supplementary Tables 4-6). The double stenting group showed a trend toward fewer adverse events (PEP: 20.3% vs 33.3%; cholangitis: 3.1% vs 8.3%) and lower costs (Table 5). The control group for this comparison was heterogeneous, combining patients with a single biliary stent (n = 4), a single pancreatic stent (n = 6), and no stent (n = 2), which limits interpretability.
Table 5 Subgroup analysis of double stents on postoperative outcomes, n (%).
Characteristics
Double stent group (n = 64)
Control group (n = 12)
P value
Complications
Pancreatitis
13 (20.3)
4 (33.3)
0.538
Cholangitis
2 (3.1)
1 (8.3)
0.407
Bleeding
2 (3.1)
0 (0)
1.000
Perforation
0 (0)
0 (0)
1.000
Papillary stenosis
1 (1.5)
0 (0)
1.000
Length of hospital stay, days, median (interquartile range)
9.0 (7.3, 11.0)
10.0 (8.3, 19.8)
0.196
hospitalization expenses, CNY, median (interquartile range)
Clip closure: No statistically significant differences were observed between the two groups in terms of patient characteristics and lesion features (Supplementary Tables 7-9). Patients undergoing prophylactic clipping had a markedly lower rate of delayed bleeding (1.4% vs 11.1%) and shorter hospital stay (9.0 days vs 11.0 days), although differences were not statistically significant. Rates of PEP and cholangitis were similar between groups (Table 6).
Table 6 Subgroup analysis of clips closure on postoperative outcomes, n (%).
Characteristics
Metal clips closure group (n = 67)
Non-metal clips closure group (n = 9)
P value
Complications
Pancreatitis
15 (22.3)
2 (22.2)
1.000
Cholangitis
2 (2.9)
1 (11.1)
0.319
Bleeding
1 (1.4)
1 (11.1)
0.224
Perforation
0 (0)
0 (0)
1.000
Papillary stenosis
1 (1.4)
0 (0)
1.000
Length of hospital stay, day, median (interquartile range)
9.0 (8.0, 11.0)
11.0 (7.5, 13.5)
0.403
hospitalization expenses, CNY, median (interquartile range)
Although uncommon, duodenal papillary neoplasms require complete resection due to their malignant potential[19]. EP is a safe and effective minimally invasive treatment modality. This study reviewed outcomes in 76 patients treated with EP at our center to report our clinical experience.
Consistent with the literature, most patients (55.2%) were asymptomatic, and laboratory tests lacked specificity. Meticulous pre-procedural evaluation is essential: Side-viewing duodenoscopy to identify malignant features (e.g., umbilication, ulceration, rigidity[15,20,21]) and subsequent endoscopic ultrasound to assess invasion depth and intraductal extension are both critical. All patients in this study had mucosal or submucosal lesions without intraductal extension, a finding that supported endoscopic resection.
The utility of submucosal injection remains controversial[22,23]. Some authors argue that ampullary anatomy prevents consistent lifting and may hinder en bloc resection[13,24-28]. We propose that injection acts as a strategic tool for sculpting the lesion rather than simple lifting it. By repositioning the lesion, injection may facilitate complete snare capture - especially of the posterior and distal margins, which are poorly visualized with a side-viewing duodenoscope. Our 96.9% R0 rate in the injection group compares favorably with reported rates (47%-93%)[16]. Importantly, injection neither prolonged procedure time nor increased adverse events and it may improve pathological assessment by preserving a clear mucosal margin[29]. However, it must be acknowledged that the lesions in this study were relatively small and that no statistically significant differences were observed. Nevertheless, we recommend selective submucosal injection during the EP to increase the complete resection rate.
Post-procedural adverse events, particularly pancreatitis, define the safety profile of EP. Prophylactic pancreatic stenting is recommended by guidelines[13], but routine biliary stenting remains debated[6,30]. We advocate a “double stenting” strategy to divert both biliary and pancreatic away from the resection bed, thereby theoretically minimizing chemical irritation and reducing risks of bleeding and stenosis[31-33]. This protocol is prioritizes procedural safety; we abort cannulation attempts during difficult to avoid trauma-induced complications[27,34]. In our cohort, double stenting was successful in 84.2% of patients and was associated with lower rates of PEP (20.3% vs 33.3%) and cholangitis (3.1% vs 8.3%), as well as shorter hospital stays and lower costs. However, there was no statistical difference between the two groups, and there was heterogeneity within the control group. Thus, the interpretation of this subgroup comparison is considerably constrained.
To reduce delayed bleeding (reported in 6.7%-21.6%[16,35]), we employ a strategy combining endocut resection[13,36] with prophylactic clip closure[37-39]. This approach, applied in 88.2% of our cohort, resulted in a low overall delayed bleeding rate of 2.6%. Subgroup analysis showed a strong protective trend (1.4% vs 11.1%) without increasing pancreatitis or cholangitis. Therefore, these data support the safety of prophylactic clipping but do not yet constitute definitive evidence of its efficacy.
In addition to the data-driven findings above, we offer the following clinical observations from our practice. First, regarding stenting technique, we utilize a “long outside, short inside” stent positioning strategy to support the duct orifice and drain secretions away from the wound. This aligns with Wu et al[31], who used “overlength” stents to divert biliopancreatic juice to the proximal jejunum to prevent delayed perforation-a complication notably absent in our series. Regarding stent removal, while the literature varies between 1 and 3 months[13,31,40], we elect to remove stents at 1 month to balance edema resolution against stent-related risks.
Second, regarding wound closure, although the anal margin is traditionally prioritized[37,40], we contend that oral margin is equally critical; informed by the anatomical study of Mirjalili and Stringer[41], which demonstrated that the main papillary artery typically penetrates at this location. Consequently, we place a targeted clip at this specific site to secure arterial inflow. Clips also serve as radiopaque landmarks for salvage transarterial embolization if needed.
Third, PEP remains the most common complication[16,42]. The primary mechanism involves pancreatic orifice obstruction due to thermal injury and edema. While prophylactic stenting is the preventive cornerstone[13,16,43], it is not always feasible (success rates 57.7%-99.6%[44-47]). We have observed that deeply resecting the sphincter of Oddi complex during EP may facilitate unroofing of the pancreatic orifice, potentially aiding subsequent cannulation. These practice-based observations have not been formally evaluated as study variables.
Notably, in our exploration of risk factors for PEP (Supplementary Table 10), we made a novel observation: Of all the variables analyzed - including stent placement, lesion size, and pathology[6,34] - pre-procedural hypokalemia was the only factor associated with pancreatitis. In the present cohort, hypokalemia was present in 10 patients (13.2%); of these, 7 developed PEP. The mean pre-procedural potassium level was lower in patients who developed PEP than in those who did not (3.7 ± 0.4 mmol/L vs 4.0 ± 0.3 mmol/L, P = 0.011). This association has rarely been discussed in the EP literature. We hypothesize that low serum potassium may disrupt acinar cell ion homeostasis and impair pancreatic microcirculation, thereby potentially increasing susceptibility to injury[48-51]. Although this finding is preliminary, greater attention should be paid to preoperative serum potassium levels to reduce the occurrence of postoperative pancreatitis.
The long-term recurrence rate, which ranges from 0% to 33%[39], is the ultimate measure of EP efficacy. In our cohort, no recurrences were observed, and residual adenoma was found in only 3.9% of cases. We attribute this success to our rigorous resection protocol, though we acknowledge the limitations of our follow-up duration. Current evidence suggests that a 2-year surveillance window captures only approximately 60% of recurrences[15,52]. We strongly support adhering to current guidelines, which mandate a minimum of five years of surveillance to detect late recurrences[13,21], our follow-up is ongoing.
Our study has several important limitations inherent to its retrospective, single-center design. Selection and information biases cannot be excluded. Furthermore, our results, achieved by highly experienced endoscopists at a tertiary referral center, may not be generalizable to all clinical settings. Most critically, the sample size-particularly of the control subgroups in our technical analyses-was small. This undoubtedly limited the statistical power to detect significant differences, therefore, all subgroup findings should be interpreted as hypothesis-generating rather than confirmatory. Finally, the follow-up duration of our cohort is insufficient, precluding definitive conclusions about long-term recurrence.
CONCLUSION
In conclusion, this study demonstrates that a standardized EP protocol-integrating strategic submucosal injection, proactive double stenting, and prophylactic clip closure-can achieve a high complete resection rate with a favorable adverse event. We further identified pre-procedural hypokalemia as a novel, modifiable risk factor for PEP. Although the retrospective, single-center design and limited sample size constrain the inferences that can be drawn, the rarity of ampullary neoplasms and the practical barriers to conducting large prospective randomized trials in this field mean that real-world evidence of this kind still provides clinically meaningful guidance while higher-level evidence is awaited. These findings suggest that integrating a multifaceted technical strategy with preoperative metabolic optimization may further enhance the safety of EP.
Hirota WK, Zuckerman MJ, Adler DG, Davila RE, Egan J, Leighton JA, Qureshi WA, Rajan E, Fanelli R, Wheeler-Harbaugh J, Baron TH, Faigel DO; Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract.Gastrointest Endosc. 2006;63:570-580.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 411][Cited by in RCA: 313][Article Influence: 15.7][Reference Citation Analysis (33)]
Abe S, Sakai A, Masuda A, Miki M, Harada Y, Nagao K, Inomata N, Kohashi S, Uemura H, Masuda S, Ashina S, Gonda M, Yamakawa K, Tsujimae M, Yamada Y, Tanaka T, Kobayashi T, Nakano R, Shiomi H, Tsugawa D, Yanagimoto H, Ajiki T, Kanzawa M, Fukumoto T, Itoh T, Kodama Y. Advantage of endoscopic papillectomy for ampullary tumors as an alternative treatment for pancreatoduodenectomy.Sci Rep. 2022;12:15134.
[RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)][Cited by in RCA: 10][Reference Citation Analysis (0)]
Vanbiervliet G, Strijker M, Arvanitakis M, Aelvoet A, Arnelo U, Beyna T, Busch O, Deprez PH, Kunovsky L, Larghi A, Manes G, Moss A, Napoleon B, Nayar M, Pérez-Cuadrado-Robles E, Seewald S, Barthet M, van Hooft JE. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.Endoscopy. 2021;53:429-448.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 143][Cited by in RCA: 127][Article Influence: 25.4][Reference Citation Analysis (3)]
Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, Beyna T, Dinis-Ribeiro M, Hritz I, Mariani A, Paspatis G, Radaelli F, Lakhtakia S, Veitch AM, van Hooft JE. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.Endoscopy. 2020;52:127-149.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 729][Cited by in RCA: 669][Article Influence: 111.5][Reference Citation Analysis (5)]
Kawashima H, Ohno E, Ishikawa T, Iida T, Tanaka H, Furukawa K, Nakamura M, Honda T, Hashimoto S, Itoh A, Ishigami M, Hirooka Y, Fujishiro M. Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: Analysis of factors related to treatment outcome and long-term prognosis.Dig Endosc. 2021;33:858-869.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 21][Cited by in RCA: 32][Article Influence: 6.4][Reference Citation Analysis (1)]
