Can prophylactic argon plasma coagulation reduce delayed post-papillectomy bleeding? A prospective multicenter trial

Jae Kook Yang, Jong Jin Hyun, Tae Hoon Lee, Jun Ho Choi, Yun Nah Lee, Jung Wan Choe, Jin Seok Park, Chang Il Kwon, Seok Jeong, Hong Ja Kim, Jong Ho Moon, Sang Heum Park

Research output: Contribution to journalArticle

Abstract

Background and Aim: Endoscopic post-papillectomy bleeding occurs in 3% to 20% of the cases, and delayed bleeding is also problematic. However, there is no consensus on how to reduce delayed post-papillectomy bleeding. The aim of this study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) to minimize delayed bleeding and reduce the persistence of residual tumors after endoscopic papillectomy. Methods: In a prospective pilot study of patients with benign ampullary tumors, the prophylactic APC group underwent APC at the resection margin following a conventional snaring papillectomy. Then, 24 h later after the papillectomy, all patients underwent a follow-up duodenoscopy to identify post-papillectomy bleeding and were followed up until 12 months. The main outcomes were the delayed (≥24 h) post-papillectomy bleeding rate and the tumor persistence rate. Results: The delayed post-papillectomy bleeding rate was 30.8% (8/26) in the prophylactic APC group and 21.4% (6/28) in the non-APC group (P = 0.434). The post-procedure pancreatitis rates were 23.1% (6/26) and 35.7% (10/28), respectively (P = 0.310). The rate of tumor persistence did not differ between the two groups at 1 month (12.5% vs 7.4%, P = 0.656), 3 months (4.2% vs 3.7%, P = 1.00), 6 months (8.3% vs 3.7%, P = 0.595), and 12 months (0% vs 3.7%, P = 1.00). There were no procedure-related mortalities or serious complications. Conclusion: Prophylactic APC may not be effective in reducing delayed post-papillectomy bleeding or remnant tumor ablation immediately after conventional papillectomy (Clinical trial registration—cris.nih.go.kr; KCT0001955).

Original languageEnglish
JournalJournal of Gastroenterology and Hepatology (Australia)
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Ampulla of Vater
  • Argon plasma coagulation
  • Bleeding
  • Papillectomy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Yang, J. K., Hyun, J. J., Lee, T. H., Choi, J. H., Lee, Y. N., Choe, J. W., Park, J. S., Kwon, C. I., Jeong, S., Kim, H. J., Moon, J. H., & Park, S. H. (Accepted/In press). Can prophylactic argon plasma coagulation reduce delayed post-papillectomy bleeding? A prospective multicenter trial. Journal of Gastroenterology and Hepatology (Australia). https://doi.org/10.1111/jgh.15186