Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Endoscopy. 2013 Oct;45(10):838-41. doi: 10.1055/s-0033-1344392. Epub 2013 Aug 5.
After endoscopic papillectomy, pancreatic duct stenting is important in preventing pancreatitis, but duct cannulation can be difficult following conventional snare resection. Pancreatic duct wire-guided endoscopic snaring before resection can reduce the post-procedure stenting failure rate. We evaluated the usefulness of this approach.
Pancreatic duct wire-guided endoscopic papillectomy was performed in 72 patients with ampullary adenoma. The snare loop was passed over a guide wire inserted into the pancreatic duct. After resection, a pancreatic stent was immediately placed along or alongside the guide wire.
Pancreatic duct stenting was successful in all patients after endoscopic papillectomy. Post-procedure pancreatitis occurred in 6/72 (8 %), but was mild and resolved with conservative treatment. Complete endoscopic resection of ampullary adenoma was achieved in 65/72 (90 %), with en bloc resection in 60/72 (83 %). There was no procedure-associated mortality. Follow-up (mean 23.7 months) showed recurrence in 5/65 (8 %) who had undergone complete resection.
Pancreatic duct wire-guided endoscopic snare papillectomy for ampullary adenoma effectively facilitated pancreatic duct stenting to prevent severe post-procedure pancreatitis.
内镜下乳头括约肌切开术（endoscopic papillectomy，EP）后，放置胰管支架对于预防胰腺炎非常重要，但在常规套扎切除后进行胰管插管可能较为困难。在切除前采用导丝引导的内镜套扎对胰管进行预切开，可以降低术后支架置入失败的发生率。我们评估了这种方法的有效性。
对 72 例壶腹周围腺瘤患者实施了导丝引导的内镜乳头括约肌切开术。将套扎圈套在插入胰管的导丝上。切除后，立即沿着或沿着导丝放置胰管支架。
所有患者在 EP 后均成功进行了胰管支架置入。72 例患者中有 6 例（8 %）发生术后胰腺炎，但为轻度，经保守治疗后缓解。65 例（90 %）患者完全切除了壶腹腺瘤，其中 60 例（83 %）为整块切除。无与操作相关的死亡病例。随访（平均 23.7 个月）显示，完全切除的 65 例患者中有 5 例（8 %）复发。
对于壶腹周围腺瘤，导丝引导的内镜套扎乳头括约肌切开术可有效促进胰管支架置入，预防严重的术后胰腺炎。
