title: Endoscopic wire-guided papillectomy versus conventional papillectomy for ampullary tumors: A prospective comparative pilot study.
abstract: OBJECTIVE
  A major concern about endoscopic snare papillectomy (ESP) is the risk of procedure-related pancreatitis. To maintain pancreatic duct access for stent placement after ESP, wire-guided ESP (WP) was introduced. The aim of the study was to compare post-procedure pancreatitis rates, the success rate of pancreatic stent insertion, and complete resection rates between WP and conventional ESP (CP) procedures.
  
  
  METHODS
  This was a multi-center, prospective, randomized pilot study. Forty-five patients with ampullary tumors were randomly assigned to a WP group (n = 22) or a CP group (n = 23). In the WP group, a guidewire was placed in the pancreatic duct prior to ESP. A 5-Fr pancreatic stent was passed over the guidewire and placed across the pancreatic duct orifice.
  
  
  RESULTS
  Complete resection was achieved in 20 patients (91%) in the WP group and 18 patients (78%) in the CP group (P = 0.414). A pancreatic stent was placed successfully in all patients in the WP group but in only 15 patients (65%) in the CP group (P = 0.004). Post-papillectomy pancreatitis occurred in four (18%) patients in the WP and three (13%) patients in the CP groups (P = 0.960). In the CP group, three of eight (37.5%) patients without stents developed pancreatitis compared with zero of 15 patients with stents (P = 0.032).
  
  
  CONCLUSIONS
  The WP method is a useful technique used to insert a pancreatic stent after ESP, compared with CP. However, there was no significant difference in the post-procedure pancreatitis or complete resection rates between the two methods.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Tae Yoon
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Chan Sup
authors.initials: CS
authors.lastname: Shim
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Hyoung-Chul
authors.initials: HC
authors.lastname: Oh
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: ampullary tumor; endoscopic papillectomy; pancreatic stent; pancreatitis