Wire-guided endoscopic snare papillectomy for tumors of the major duodenal papilla.
BACKGROUND
Endoscopic excision for adenoma of the major duodenal papilla was introduced as an alternative to surgery, but postprocedure pancreatitis is a serious drawback. This study assessed the feasibility and the safety of endoscopic papillectomy with a guidewire and pancreatic-duct stent insertion to prevent pancreatitis.


METHODS
Six patients were enrolled. The snare loop was passed over a guidewire that had been inserted into the pancreatic duct. Immediately after snare resection, a pancreatic stent was placed along the indwelling guidewire.


RESULTS
En bloc papillectomy and pancreatic stent insertion were performed successfully in all patients. Pancreatitis did not develop acutely in any patient. Complications included cholangitis (n = 1) and late-onset pancreatitis owing to the pancreatic stent (n = 1). Scant residual adenomatous tissue was present at resection margins in two patients and was treated endoscopically.


CONCLUSIONS
Wire-guided endoscopic snare papillectomy in selected patients is a useful technique that maintains pancreatic-duct access for stent placement. This appears to prevent pancreatitis and to improve the outcome for patients undergoing endoscopic resection of papillary tumors.
Moon
Jong Ho
JH
Department of Internal Medicine, Digestive Disease Center, Institute for Digestive Research, Soon Chun Hyang University College of Medicine, 657 Hannam-Dong, Yongsan-Ku, Seoul 140-743, Korea.
Cha
Sang Woo
SW
Cho
Young Deok
YD
Ryu
Chang Beom
CB
Cheon
Young Koog
YK
Kwon
Kye Won
KW
Kim
Young Seok
YS
Kim
Yun Soo
YS
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Shim
Chan Sup
CS
Kim
Boo Sung
BS
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged