Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors
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Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed toinvestigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for preventionof bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopicpapillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in thesimple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7%(96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8%(3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates ofpositive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions: HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopicpapillectomy for ampullary tumors.
Abstract
Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed toinvestigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for preventionof bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopicpapillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in thesimple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7%(96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8%(3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates ofpositive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions: HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopicpapillectomy for ampullary tumors.
참고문헌 (22)
- "Gastroenterological Endoscopy", 1999, 284~295
- Binmoeller KF, "Endoscopic snare excision of benign adenomas of the papilla of Vater", Gastrointest Endosc, 39, pp.127~131 (1993)
- Norton ID, "Safety and outcome of endoscopic snare excision of the major duodenal papilla", Gastrointest Endosc, 56, pp.239~243 (2002)
- Cheng CL, "Endoscopic snare papillectomy for tumors of the duodenal papillae", Gastrointest Endosc, 60, pp.757~764 (2004)
- Bohnacker S, "Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth", Gastrointest Endosc, 62, pp.551~560 (2005)
- Catalano MF, "Endoscopic management of adenoma of the major duodenal papilla", Gastrointest Endosc, 59, pp.225~232 (2004)
- Igarashi Y, "Endoscopic snare excision for a major papilla tumor", Dig Endosc, 17, pp.179~182 (2005)
- Seifert E, "Adenoma and carcinoma of the duodenum and papilla of Vater : a clinicopathologic study", Am J Gastroenterol, 87, pp.37~42 (1992)
- Stolte M, "Adenoma-carcinoma sequence in the papilla of Vater", Scand J Gastroenterol, 31, pp.376~382 (1996)
- Hirao M, "Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine", Gastrointest Endosc, 34, pp.264~269 (1988)
- Kanda Y, "Investigation of the freely available easy-to-use software ‘EZR’for medical statistics", Bone Marrow Transplant, 48, pp.452~458 (2013)
- Han J, "Endoscopic papillectomy for adenomas of the major duodenal papilla(with video)", Gastrointest Endosc, 63, pp.292~301 (2006)
- Espinel J, "Endoscopic ampullectomy : a technical review", Rev Esp Enferm Dig, 108, pp.271~278 (2016)
- Desilets DJ, "Endoscopic management of tumors of the major duodenal papilla : refined techniques to improve outcome and avoid complications", Gastrointest Endosc, 54, pp.202~208 (2001)
- Bassan M, "Endoscopic ampullectomy : a practical guide", J Interv Gastroenterol, 2, pp.23~30 (2012)
- Hyun JJ, "A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma", Gastrointest Endosc, 85, pp.746~755 (2017)
- ASGE Standards of Practice Committee, "The role of endoscopy in ampullary and duodenal adenomas", Gastrointest Endosc, 82, pp.773~781 (2015)
- Ito K, "Endoscopic diagnosis and treatment of ampullary neoplasm(with video)", Dig Endosc, 23, pp.113~117 (2011)
- Harewood GC, "Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla", Gastrointest Endosc, 62, pp.367~370 (2005)
- Dumonceau JM, "European Society of Gastrointestinal Endoscopy(ESGE)guideline : prophylaxis of post-ERCP pancreatitis", Endoscopy, 42, pp.503~515 (2010)
- Irani S, "Papillectomy for ampullary neoplasm : results of a single referral center over a 10-year period", Gastrointest Endosc, 70, pp.923~932 (2009)
- Aiura K, "Balloon-catheter-assisted endoscopic snare papillectomy for benign tumors of the major duodenal papilla", Gastrointest Endosc, 57, pp.743~747 (2003)