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Cited 33 time in webofscience Cited 43 time in scopus
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A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma

Authors
Hyun, Jong JinLee, Tae HoonPark, Jin-SeokHan, Joung-HoJeong, SeokPark, Seon MeeLee, Hong SikMoon, Jong HoPark, Sang-Heum
Issue Date
Apr-2017
Publisher
MOSBY-ELSEVIER
Citation
GASTROINTESTINAL ENDOSCOPY, v.85, no.4, pp.746 - 755
Indexed
SCIE
SCOPUS
Journal Title
GASTROINTESTINAL ENDOSCOPY
Volume
85
Number
4
Start Page
746
End Page
755
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/5148
DOI
10.1016/j.gie.2016.08.013
ISSN
0016-5107
Abstract
Background and Aims: Whether or not submucosal injection of a diluted epinephrine solution should be used to lift ampullary tumors during endoscopic snare papillectomy is unclear. This study aimed to investigate the clinical efficacy of a simple snaring method versus submucosal injection for papillectomy. Methods: A prospective multicenter study was performed at 4 tertiary referral centers. Patients with papillary lesions were randomized to undergo either simple snare papillectomy (SSP) or submucosal injection papillectomy (SIP) using 1: 10,000 diluted epinephrine. The main outcome measures were complete resection rate and post-papillectomy adverse events. Results: A total of 50 patients with biopsy-proven papillary adenomas were enrolled. Complete resection rates in the SSP and SIP groups were 80.8% (21/26) and 50.0% (12/24), respectively (P = .02). However, tumor persistence at 1 month (15.4% vs 8.3%, P = .62) and recurrence at 12 months (12.0% vs 9.5%, P = .58) did not differ despite initial differences in the prevalence of a positive resection margin. The mean tumor size was 12 mm in the SSP group and 9.29 mm in the SIP group. Post-papillectomy bleeding developed in 42.3% (11/26) and 45.8% (11/24) of patients, respectively (P = .80). Delayed bleeding (>12 h) occurred in 27.3% (3/11) and 36.4% (4/11) of patients, respectively (P = .50). Post-procedure pancreatitis occurred in 15.4% (4/26) and 25% (6/24) of patients, respectively (P = .49). Pancreatitis severity did not differ between the groups, and there were no procedure-related mortalities. Conclusions: Although the recurrence rate was similar between the SSP and SIP groups, SIP showed no advantage over SSP in terms of achieving complete resection or decreasing the frequency of post-papillectomy adverse events, such as bleeding. SSP may thus be a simpler and primarily recommendable technique. (Clinical trial registration number: NCT02165852.)
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Lee, Hong Sik
안암병원 (Department of Gastroenterology and Hepatology, Anam Hospital)
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