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Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)

BACKGROUND: Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. Endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical...

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Autores principales: Jiang, Lei, Ling-Hu, En-Qiang, Chai, Ning-Li, Li, Wen, Cai, Feng-Chun, Li, Ming-Yang, Guo, Xu, Meng, Jiang-Yun, Wang, Xiang-Dong, Tang, Ping, Zhu, Jing, Du, Hong, Wang, Hong-Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596639/
https://www.ncbi.nlm.nih.gov/pubmed/33177797
http://dx.doi.org/10.3748/wjg.v26.i40.6250
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author Jiang, Lei
Ling-Hu, En-Qiang
Chai, Ning-Li
Li, Wen
Cai, Feng-Chun
Li, Ming-Yang
Guo, Xu
Meng, Jiang-Yun
Wang, Xiang-Dong
Tang, Ping
Zhu, Jing
Du, Hong
Wang, Hong-Bin
author_facet Jiang, Lei
Ling-Hu, En-Qiang
Chai, Ning-Li
Li, Wen
Cai, Feng-Chun
Li, Ming-Yang
Guo, Xu
Meng, Jiang-Yun
Wang, Xiang-Dong
Tang, Ping
Zhu, Jing
Du, Hong
Wang, Hong-Bin
author_sort Jiang, Lei
collection PubMed
description BACKGROUND: Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. Endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical adverse events that restrict its wider use. There is no standard procedure for endoscopic papillectomy yet. The procedure is relevant to postoperative adverse events. AIM: To reduce the postoperative adverse event rates and improve patients’ postoperative condition, we developed a standard novel procedure for endoscopic papillectomy. METHODS: The novel endoscopic papillectomy had two main modifications based on the conventional method: The isolation of bile from pancreatic juice with a bile duct stent and wound surface protection with metal clips and fibrin glue. We performed a single-center retrospective comparison study on the novel and conventional methods to examine the feasibility of the novel method for reducing postoperative adverse events. RESULTS: A total of 76 patients, of whom 23 underwent the novel procedure and 53 underwent the conventional procedure, were retrospectively evaluated in this study. The postoperative bleeding and pancreatitis rates of the novel method were significantly lower than those of the conventional method (0 vs 20.75%, P = 0.028, and 17.4% vs 41.5%, P = 0.042, respectively). After applying the novel method, the most critical adverse event, perforation, was entirely prevented, compared to a prevalence of 5.66% with the conventional method. Several postoperative symptoms, including fever, rapid pulse, and decrease in hemoglobin level, were significantly less frequent in the novel group (P = 0.042, 0.049, and 0.014, respectively). Overall, the total adverse event rate of the novel method was lower (0 vs 24.5%, P = 0.007) than that of the conventional method. CONCLUSION: Patients who underwent the novel procedure had lower postoperative adverse event rates. This study demonstrates the potential efficacy and safety of the novel endoscopic papillectomy in reducing postoperative adverse events.
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spelling pubmed-75966392020-11-10 Novel endoscopic papillectomy for reducing postoperative adverse events (with videos) Jiang, Lei Ling-Hu, En-Qiang Chai, Ning-Li Li, Wen Cai, Feng-Chun Li, Ming-Yang Guo, Xu Meng, Jiang-Yun Wang, Xiang-Dong Tang, Ping Zhu, Jing Du, Hong Wang, Hong-Bin World J Gastroenterol Retrospective Study BACKGROUND: Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. Endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical adverse events that restrict its wider use. There is no standard procedure for endoscopic papillectomy yet. The procedure is relevant to postoperative adverse events. AIM: To reduce the postoperative adverse event rates and improve patients’ postoperative condition, we developed a standard novel procedure for endoscopic papillectomy. METHODS: The novel endoscopic papillectomy had two main modifications based on the conventional method: The isolation of bile from pancreatic juice with a bile duct stent and wound surface protection with metal clips and fibrin glue. We performed a single-center retrospective comparison study on the novel and conventional methods to examine the feasibility of the novel method for reducing postoperative adverse events. RESULTS: A total of 76 patients, of whom 23 underwent the novel procedure and 53 underwent the conventional procedure, were retrospectively evaluated in this study. The postoperative bleeding and pancreatitis rates of the novel method were significantly lower than those of the conventional method (0 vs 20.75%, P = 0.028, and 17.4% vs 41.5%, P = 0.042, respectively). After applying the novel method, the most critical adverse event, perforation, was entirely prevented, compared to a prevalence of 5.66% with the conventional method. Several postoperative symptoms, including fever, rapid pulse, and decrease in hemoglobin level, were significantly less frequent in the novel group (P = 0.042, 0.049, and 0.014, respectively). Overall, the total adverse event rate of the novel method was lower (0 vs 24.5%, P = 0.007) than that of the conventional method. CONCLUSION: Patients who underwent the novel procedure had lower postoperative adverse event rates. This study demonstrates the potential efficacy and safety of the novel endoscopic papillectomy in reducing postoperative adverse events. Baishideng Publishing Group Inc 2020-10-28 2020-10-28 /pmc/articles/PMC7596639/ /pubmed/33177797 http://dx.doi.org/10.3748/wjg.v26.i40.6250 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Jiang, Lei
Ling-Hu, En-Qiang
Chai, Ning-Li
Li, Wen
Cai, Feng-Chun
Li, Ming-Yang
Guo, Xu
Meng, Jiang-Yun
Wang, Xiang-Dong
Tang, Ping
Zhu, Jing
Du, Hong
Wang, Hong-Bin
Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title_full Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title_fullStr Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title_full_unstemmed Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title_short Novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
title_sort novel endoscopic papillectomy for reducing postoperative adverse events (with videos)
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596639/
https://www.ncbi.nlm.nih.gov/pubmed/33177797
http://dx.doi.org/10.3748/wjg.v26.i40.6250
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