Clinical outcomes of endoscopic papillectomy: The experience in a Chinese tertiary hospital

Table 1 Baseline characteristics of patients, n (%)/mean ± SD/median (interquartile range)

Characteristics	Patients (n = 76)
Gender
Male	44 (58)
Female	32 (42)
Age, years	61.2 ± 9.8
BMI, kg/m2	24.1 ± 3.4
Clinical symptoms
Asymptomatic	42 (55.2)
Fever	3 (3.9)
Abdominal pain	22 (28.9)
Abdominal distension	7 (9.2)
Heartburn	2 (2.6)
Comorbidities
Hypertension	30 (39.4)
Diabetes	14 (18.4)
Cardiovascular disease	11 (14.4)
Malignancy	6 (7.9)
Oral anticoagulant	8 (10.5)
Smoking history	24 (31.6)
Alcohol intake	27 (35.5)
Tumor marker
CEA, ng/mL	1.9 (0.84, 2.8)
CA19-9, U/mL	7.5 (2.5, 15.1)
Blood routine test
WBC, 109/L	5.8 (4.8, 6.6)
NEU%	60.4 ± 10.4
HGB, g/L	139.5 ± 12.7
PLT, 109/L	221 (186, 248)
Liver function test
TBIL, μmol/L	12.6 (9.3, 18.9)
DBIL, μmol/L	3.4 (2.4, 5.7)
ALT, U/L	20.2 (14.3, 29.0)
AST, U/L	20.0 (15.9, 25.9)
AKP, U/L	79.5 (62.5, 96.0)
GGT, U/L	27.6 (17.5, 52.5)
ALB, g/L	41.5 ± 4.0
Serum ions
K+ mmol/L	3.9 ± 0.3
Na+ mmol/L	141.3 ± 2.1
Coagulation function
PTs	12.2 ± 1.0
INR	1.0 ± 0.1
APTT	29.4 (26.4, 35.2)
FIB, g/L	3.1 (2.7, 3.5)
TTs	17.3 ± 0.9
Endoscopic ultrasound assessment
Hypoechoic	50 (65.8)
Isoechoic	24 (31.6)
Hyperechoic	2 (2.6)
Bile duct diameter, mm	7.5 (6.0, 10.7)
Pancreatic duct diameter, mm	2.2 (2.0, 3.0)
Tumor size, mm	15.0 (15.0, 25.0)

BMI: Body mass index; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; WBC: White blood cell; NEU: Neutrophil; HGB: Hemoglobin; PLT: Platelet; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AKP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; ALB: Albumin; PTs: Prothrombin time; INR: International normalized ratio; APTT: Activated partial thromboplastin time; FIB: Fibrinogen; TTs: Thrombin time.

Table 2 Intraoperative characteristics, n (%)

Characteristics	Patients (n = 76)
En bloc resection	69 (90.8)
Submucosal injection	65 (85.5)
Diverticulum	14 (18.4)
Hemostasis
Electrocautery hemostasis	44 (57.9)
Epinephrine spray	11 (14.5)
None	21 (27.6)
Stent implantation
Biliary stent	4 (5.3)
Pancreatic stent	6 (7.9)
Double stents	64 (84.2)
Non stent	2 (2.6)
Metal clips	67 (88.2)
Drainage tube	4 (5.3)
Procedure time, minutes, median (interquartile range)	28 (18, 33.8)

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)	37 (13, 55)
Residual adenoma	3 (3.9)
Recurrence	0 (0)

LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia.

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)	30862.1 (27958.2, 36921.7)	32147.9 (25346.0, 52082.6)	0.935
Residual adenoma	2 (3.1)	1 (9.1)	0.379
Recurrence	0 (0)	0 (0)	1.000

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)	30835.9 (27567.0, 37598.0)	31514.4 (28742.2, 51287.6)	0.579
Residual adenoma	3 (4.6)	0 (0)	1.000
Recurrence	0 (0)	0 (0)	1.000

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)	31104.4 (27744.6, 38318.5)	29379.3 (26400.0, 39068.1)	0.706
Residual adenoma	3 (4.4)	0 (0)	1.000
Recurrence	0 (0)	0 (0)	1.000