| International Session（Symposium）10(JGES・JSGE・JSGS・JSGCS) |
| Sat. November 7th 14:30 - 17:00 Room 11: Portopia Hotel South Wing Topaz |
| Endoscopic papillectomy - tips and tricks | |||
| Eisuke Iwasaki1, Seiichiro Fukuhara2, Takanori Kanai1 | |||
| 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 2Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine | |||
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| Background and Aim: Endoscopic papillectomy is a minimally invasive therapy for duodenal ampullary adenoma. With advances in endoscopic devices and methods, it became a safe and efficacious therapeutic procedure that can avoid the need for open surgery. The incidence of adverse events and risk factors for post ampullectomy pancreatitis and delayed bleeding were evaluated. Methods: A retrospective study was conducted on 41 patients of pathologically proven ampullary adenoma who underwent endoscopic papillectomy. Results: After endoscopic papillectomy, either a 5-Fr 5-cm or shorter plastic stent (n=17) or a 5 -Fr 7-cm stent (n=24) was placed in the pancreatic duct. Sufficient closure (n = 27) or insufficient closure (n = 14) were then performed on mucosal resection ulcers. Pancreatitis and delayed bleeding occurred in 9 and 6 patients, respectively. The longer (7cm or more) pancreatic stent deployment was a significant factor for prevention of post PAP. (p=0.039). The sufficient closure using clips was a significant factor for prevention of post delayed bleeding. (p=0.039). Conclusions: Longer pancreatic plastic stent should be used for prevention of post papillectomy pancreatitis. Sufficient closure for caudal side of ulcer probably prevents the delayed bleeding. |
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Index Term 1: Endoscopic papillectomy Index Term 2: Ampullary adenoma |
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