Endoscopic resection of ampullary adenoma after a new insulated plastic pancreatic stent placement: a pilot study.
OBJECTIVE
Although pancreatic stent insertion is recommended for the prevention of post-procedure pancreatitis during endoscopic papillectomy, insertion of the stent after the procedure can be technically difficult. The aim of the present study was to determine the feasibility and safety of inserting a newly developed insulated pancreatic stent before endoscopic papillectomy.


METHODS
We conducted a prospective pilot study involving 11 consecutive patients with adenomas of the major duodenal papilla. After a 5F polytetrafluoroethylene-insulated pancreatic stent was inserted through the tumor, the stent and tumor were simultaneously grasped with a snare. After resection of the tumor with the stent in place, the tumor was incised perpendicularly along the edge of the stent for retrieval of the specimen.


RESULTS
In all patients, the insulated pancreatic stents were successfully inserted before endoscopic papillectomy and were resistant to electrical current; retrieval of the specimen was technically feasible and successful without stent migration. There were no stent-related complications, but five papillectomy-related complications (including mild bleeding [n = 4] and late papillary stenosis [n = 1]) occurred without any episodes of acute pancreatitis or perforation.


CONCLUSIONS
Pre-resection stenting with a polytetrafluoroethylene-insulated stent in patients with adenomas of the major duodenal papilla is a feasible and useful technique to prevent pancreatitis.
Hwang
Jae Chul
JC
Department of Gastroenterology, Ajou University School of Medicine, Yongtong-gu, Suwon, Korea.
Kim
Jin Hong
JH
Lim
Sun Gyo
SG
Yoo
Byung Moo
BM
Cho
Sung Won
SW
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D020698:Duodenoscopes; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011138:Polytetrafluoroethylene; D011300:Preoperative Care; D011446:Prospective Studies; D011474:Prosthesis Design; D056910:Republic of Korea; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation; D015607:Stents; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene