title: A novel endoscopic papillectomy after a pancreatic stent placement above the pancreatic duct orifice: inside pancreatic stenting papillectomy.
abstract: BACKGROUND
  Although pancreatic stenting is recommended for the prevention of postprocedure pancreatitis during endoscopic papillectomy (EP), in some patients it is technically difficult to perform postprocedure insertion of a pancreatic stent after endoscopic resection.
  
  
  OBJECTIVE
  This study assessed the feasibility of a novel EP for the purpose of reliable post-EP pancreatic stenting.
  
  
  METHODS
  We conducted a prospective pilot study involving 10 consecutive patients with tumor of the major duodenal papilla. We developed a novel pancreatic stent, which is attached to a suture, and devised a method by which the stent is first placed at an upstream migration into the major pancreatic duct above the orifice before resection and then placed at an appropriate location after endoscopic resection by pulling the suture attached to the stent [inside pancreatic stenting papillectomy (IPSP)].
  
  
  RESULTS
  The pancreatic stent was successfully placed at an upstream migration into the pancreatic duct above the orifice in 9 of the 10 patients. For the 9 patients with successful pancreatic stent placement, IPSP was performed. Although the suture was cut in 1 patient, pancreatic stents could be placed appropriately across the orifice by pulling the suture in all patients. Although bleeding occurred in 3 patients, there was no pos-procedure pancreatitis.
  
  
  CONCLUSIONS
  IPSP is a practicable method allowing reliable post-EP pancreatic stenting and can contribute to pancreatitis prevention. However, larger studies need to be performed before its use can be recommended.
authors.affiliation: *Department of Gastroenterology and Hepatology †Department of Gastroenterological and General Surgery, School of Medicine, St. Marianna University, Kawasaki, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakahara
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Keigo
authors.initials: K
authors.lastname: Suetani
authors.forename: Ryo
authors.initials: R
authors.lastname: Morita
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Michikawa
authors.forename: Yohei
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hattori
authors.forename: Ryuta
authors.initials: R
authors.lastname: Shigefuku
authors.forename: Seitaro
authors.initials: S
authors.lastname: Adachi
authors.forename: Moriaki
authors.initials: M
authors.lastname: Hatsugai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Matsunaga
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
mesh_terms: D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D004379:Duodenal Neoplasms / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery; D010195:Pancreatitis / Q000517:prevention & control*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D015607:Stents