Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors

Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

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Endoscopic local injection of hypertonic saline-epinephrine solution to the upper gastrointestinal bleeding: A study during the last 5-year period

The American Journal of Emergency Medicine ◽

10.1016/0735-6757(88)90172-6 ◽

1988 ◽

Vol 6 (4) ◽

pp. 395

Keyword(s):

Gastrointestinal Bleeding ◽

Hypertonic Saline ◽

Upper Gastrointestinal Bleeding ◽

Local Injection ◽

Upper Gastrointestinal

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Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(85)72213-4 ◽

1985 ◽

Vol 31 (5) ◽

pp. 313-317 ◽

Cited By ~ 71

Author(s):

M. Hirao ◽

T. Kobayashi ◽

K. Masuda ◽

S. Yamaguchi ◽

K. Noda ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Hypertonic Saline ◽

Local Injection ◽

Upper Gastrointestinal Tract ◽

Upper Gastrointestinal

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A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

Journal of Clinical Medicine ◽

10.3390/jcm9082671 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2671

Author(s):

Naminatsu Takahara ◽

Yosuke Tsuji ◽

Yousuke Nakai ◽

Yukari Suzuki ◽

Akiyuki Inokuma ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Demographic Data ◽

Postoperative Bleeding ◽

Incomplete Resection ◽

Proof Of Concept ◽

Procedure Time ◽

Concept Study ◽

Submucosal Dissection ◽

Endoscopic Papillectomy ◽

Ampullary Tumors

Background: Endoscopic papillectomy (EP) carries a potential risk of procedure-related adverse events and incomplete resection. Since hybrid endoscopic submucosal dissection (ESD) had been established as an alternative option for relatively large and difficult gastrointestinal tumors, we evaluated a novel EP with hybrid ESD (hybrid ESD-EP) for curative safe margin in this proof-of-concept study. Methods: A total of eight cases who underwent hybrid ESD-EP between 2018 and 2020 were identified from our prospectively maintained database. Hybrid ESD-EP involved a (sub)circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated. Results: En bloc resection was achieved by hybrid ESD-EP in all eight cases, with the median procedure time of 112 (range: 65–170) minutes. The median diameters of the resected specimens and tumors were 18 and 12 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in three (38%), resulting in the complete resection rate of 63%. Postoperative bleeding and pancreatitis developed in each one (13%). No tumor recurrence was observed even in those cases with uncertain vertical margin, after a median follow-up of 244 (range, 97–678) days. Conclusions: Hybrid ESD-EP seems to be feasible and promising in ensuring the lateral resection margin. However, further investigations, especially to secure the vertical margin and to shorten the procedure time, should be required.

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1169 TREATMENT OUTCOME OF ENDOSCOPIC PAPILLECTOMY ON AMPULLARY TUMORS WITH HIGH-GRADE ADENOMA OR EARLY ADENOCARCINOMA

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.884 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB103

Author(s):

Kwang Hyun Chung ◽

Min Kyu Kim ◽

Woo Hyun Paik

Keyword(s):

Treatment Outcome ◽

High Grade ◽

Endoscopic Papillectomy ◽

Early Adenocarcinoma ◽

Ampullary Tumors

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Tu1532 Comparative Study Between the Pre-Procedural Biopsy and the Final Diagnosis of Endoscopic Papillectomy: Does Pre-Biopsy Always Reflect the Ampullary Tumors?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.1240 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB598

Author(s):

Kenjiro Yamamoto ◽

Takao Itoi ◽

Atsushi Sofuni ◽

Takayoshi Tsuchiya ◽

Shujiro Tsuji ◽

...

Keyword(s):

Comparative Study ◽

Final Diagnosis ◽

Endoscopic Papillectomy ◽

Ampullary Tumors

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Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(88)71327-9 ◽

1988 ◽

Vol 34 (3) ◽

pp. 264-269 ◽

Cited By ~ 249

Author(s):

Masanori Hirao ◽

Kazuhiko Masuda ◽

Takeki Asanuma ◽

Hiroji Naka ◽

Koichi Noda ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Hypertonic Saline ◽

Endoscopic Resection ◽

Local Injection

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Endoscopic papillectomy for tumors of the major duodenal papilla

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2019136-42 ◽

2019 ◽

Vol 24 (1) ◽

pp. 36-42 ◽

Cited By ~ 2

Author(s):

I. Yu. Nedoluzhko ◽

E. I. Khon ◽

K. V. Shishin

Keyword(s):

Postoperative Bleeding ◽

Length Of Hospital Stay ◽

En Bloc Resection ◽

Prolonged Treatment ◽

Morbidity Rate ◽

Invasive Treatment ◽

En Bloc ◽

Endoscopic Papillectomy ◽

Pancreatic Duct Stenting ◽

Ampullary Tumors

Aim.To evaluate an effectiveness of endoscopic papillectomy (EA) for benign ampullary tumors.Material and methods.There were 45 patients with ampullary tumors who underwent endoscopic papillectomy in 2014–2018. Mean dimension of tumor was 2.25 ± 1.75 cm.Results.Papillectomy was successfully performed in all cases. En-bloc resection was completed in 24 cases (53%), while 21 (47%) patients had a piecemeal resection. Pancreatic duct stenting was carried out in 30 (67%) cases. Postoperative complication rate was 31%. Postoperative bleeding occurred in 8 (18%) cases, perforation in 4 (8.9%) cases, acute pancreatitis in 2 (4.4%) cases. Mortality was 4.4 % (n= 2). Local recurrence rate within 4-year period was 2.2% (n= 1). Mean length of hospital-stay was 13 days (13 ± 11) considering prolonged treatment of patients with complicated postoperative period.Conclusion.Endoscopic papillectomy is effective minimally invasive treatment of benign ampullary tumors. Regardless considerable morbidity rate, all of them may be effectively managed by medication or endoscopic procedure. EP can be considered as a first-line treatment of benign ampullary tumors.

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