Outcomes of endoscopic papillectomy after an insulated plastic pancreatic stent placement

Abstract

Outcomes of endoscopic papillectomy after an insulated plastic pancreatic stent placement _x000D_ <br>Background and aim: Insulated plastic pancreatic stent placement before endoscopic papillectomy (EP) was introduced to avoid technical difficulty in post- EP pancreatic stenting and ensure safe hemostatic procedure in case of post-EP bleeding by securing the pancreatic orifice. In the present study, we evaluated this procedure's technical success, adverse events, and long-term outcomes. _x000D_ <br>Methods: Eighty-four patients who underwent EP for ampullary adenoma between August 2006 and December 2020 were retrospectively enrolled for long-term outcome analysis. 5-Fr polytetrafluoroethylene-insulated hand-made pancreatic stent was used in this study. _x000D_ <br>Results: EP after pancreatic stents were successfully performed in 73/84 patients (86.9 %). En bloc resection was performed in 59/73 patients (80.8 %), and complete resection was achieved in 63/73 patients (86.3 %). Delayed bleeding was encountered in 7 (9.6 %) based on consensus guideline and 24 (32.9 %) on the extended definition, respectively. The incidence of pancreatitis was non- significantly less frequent in the pre-EP pancreatic stenting group than post-EP pancreatic stenting group (6.8 vs. 18.2 %; P=0.205). In the complete resection cases, tumor recurrence was encountered in 6 patients (8.2 %) with surveillance for a median of 24 months. Long-termly, 1 case (1.4 %) of cholangitis and 4 cases (5.5 %) of papillary strictures were developed. _x000D_ <br>Conclusion: The current study suggested that the EP technique after pre-EP pancreatic stent placement using an insulated PTFE plastic stent may become a reliable alternative therapy to conventional EP, considering the feasibility of pancreatic stent placement, en-bloc resectability, safety of the EP, and long-term oncologic prognosis. Keywords: endoscopic papillectomy, pancreatitis, insulated plastic pancreatic stent, ampullary adenoma, PTFE plastic stent