A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma

Jong Jin Hyun, Tae Hoon Lee, Jin Seok Park, Joung Ho Han, Seok Jeong, Seon Mee Park, Hong Sik Lee, Jong Ho Moon, Sang Heum Park

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.)

Original languageEnglish
Pages (from-to)746-755
Number of pages10
JournalGastrointestinal Endoscopy
Volume85
Issue number4
DOIs
Publication statusPublished - 2017 Apr 1

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Adenoma
Multicenter Studies
Prospective Studies
Injections
Hemorrhage
Pancreatitis
Epinephrine
Recurrence
Neoplasms
Tertiary Care Centers
Outcome Assessment (Health Care)
Clinical Trials
Biopsy
Mortality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. / Hyun, Jong Jin; Lee, Tae Hoon; Park, Jin Seok; Han, Joung Ho; Jeong, Seok; Park, Seon Mee; Lee, Hong Sik; Moon, Jong Ho; Park, Sang Heum.

In: Gastrointestinal Endoscopy, Vol. 85, No. 4, 01.04.2017, p. 746-755.

Research output: Contribution to journalArticle

Hyun, Jong Jin ; Lee, Tae Hoon ; Park, Jin Seok ; Han, Joung Ho ; Jeong, Seok ; Park, Seon Mee ; Lee, Hong Sik ; Moon, Jong Ho ; Park, Sang Heum. / A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. In: Gastrointestinal Endoscopy. 2017 ; Vol. 85, No. 4. pp. 746-755.
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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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AU - Lee, Tae Hoon

AU - Park, Jin Seok

AU - Han, Joung Ho

AU - Jeong, Seok

AU - Park, Seon Mee

AU - Lee, Hong Sik

AU - Moon, Jong Ho

AU - Park, Sang Heum

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N2 - 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.)

AB - 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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