Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Dig Endosc. 2021 Sep;33(6):977-984. doi: 10.1111/den.13907. Epub 2021 Jan 4.
Endoscopic submucosal dissection (ESD) for superficial duodenal epithelial tumors (SDETs) is technically difficult and has a high risk of adverse events. Endoscopic nasobiliary and nasopancreatic duct drainage (ENBPD) may reduce the risk of delayed adverse events by preventing exposure of the post-ESD mucosal defect to bile and pancreatic juice. This study was performed to evaluate the safety and feasibility of ENBPD after duodenal ESD.
Patients who underwent ESD for SDETs from July 2010 to March 2020 were included. We collected data on the success rate of ENBPD, adverse events due to insertion of a side-viewing endoscope, and pancreatitis after ENBPD. We also collected the clinical outcomes of duodenal ESD, including the incidence rate of delayed adverse events (defined as bleeding or perforation found after the endoscopic procedure).
Among 70 patients without complete closure of the post-ESD mucosal defect, ENBPD was successfully performed in all 25 patients including 21 cases inserted immediately after ESD and four cases inserted later. There were no adverse events associated with ENBPD procedure intraoperatively, while pancreatitis after ENBPD occurred in four patients (16.0%). No patients who underwent immediate ENBPD required intervention for an intra-abdominal abscess or delayed perforation, whereas 3 of 49 patients (6.1%) who did not undergo immediate ENBPD required surgery or drainage of an abscess.
Endoscopic nasobiliary and nasopancreatic duct drainage is technically feasible and might provide effective prophylaxis for delayed adverse events, even if a large mucosal defect is present after ESD.
内镜黏膜下剥离术（ESD）治疗十二指肠黏膜上皮肿瘤（SDETs）技术难度大，不良事件风险高。内镜鼻胆管和鼻胰管引流（ENBPD）可通过防止 ESD 后黏膜缺损暴露于胆汁和胰液来降低迟发性不良事件的风险。本研究旨在评估十二指肠 ESD 后行 ENBPD 的安全性和可行性。
纳入 2010 年 7 月至 2020 年 3 月期间接受 ESD 治疗 SDETs 的患者。我们收集了 ENBPD 成功率、插入侧视内镜相关不良事件以及 ENBPD 后胰腺炎的数据。我们还收集了十二指肠 ESD 的临床结果，包括迟发性不良事件（定义为内镜手术后发现的出血或穿孔）的发生率。
在 70 例 ESD 后黏膜缺损未完全闭合的患者中，25 例患者（包括 ESD 后即刻插入的 21 例和稍后插入的 4 例）均成功进行了 ENBPD。ENBPD 术中无不良事件发生，ENBPD 后有 4 例（16.0%）发生胰腺炎。立即行 ENBPD 的患者无一例需要介入治疗腹腔脓肿或迟发性穿孔，而未行立即 ENBPD 的 49 例患者中有 3 例（6.1%）需要手术或脓肿引流。
即使 ESD 后存在较大的黏膜缺损，内镜鼻胆管和鼻胰管引流技术上也是可行的，并且可能为迟发性不良事件提供有效的预防措施。
