Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, P.R. China.
BMC Gastroenterol. 2024 Oct 24;24(1):379. doi: 10.1186/s12876-024-03466-7.
Duodenal papillary adenoma, a potentially malignant benign tumor is primarily treated with endoscopic papillectomy. Despite its efficacy, endoscopic papillectomy has a high complication rate. This study investigates whether pancreatic duct and common bile duct stent placement can mitigate these complications.
In a retrospective observational analysis, 79 patients with duodenal papillary adenoma, treated with endoscopic papillectomy at our center, were studied. The cohort included patients who underwent endoscopic papillectomy with no stents placement, common bile duct stent placement alone, pancreatic duct stent placement alone, or stents placement in both ducts. We assessed the outcomes of endoscopic papillectomy, including complete resection rate and recurrence rate as the primary and secondary outcomes respectively. In the meantime, the incidence of complications were also analysed as the safety outcomes.
Complete resection rates did not significantly differ between patients with or without stent placement (85.7% P group vs. 89.2% N-P group, P = 0.64). Early complication rates were similar across groups. However, significant reduction in common bile duct stenosis was observed in the stenting group (0% B group vs. 10.5% N-B group, P = 0.03). Furthermore, stent placement correlated with lower adenoma recurrence rates during follow-up (2.4% P group vs. 16.2% N-P group, P = 0.03; 2.4% B group vs. 15.8% N-B group, P = 0.04).
Pancreatic duct and common bile duct stent placement in endoscopic papillectomy may decrease late complications, particularly common bile duct stenosis, and reduce the recurrence of duodenal papillary adenoma.
This study received approval from the Institutional Review Board and Ethics Committee of Beijing Friendship Hospital (Approval No. BFHHZS20230203), and retrospectively registered in www.
gov (NCT06301048, Initial Release date: 02/18/2024, Last Public Release date: 03/03/2024).
十二指肠乳头腺瘤是一种潜在恶性的良性肿瘤，主要采用内镜乳头切除术治疗。尽管内镜乳头切除术有效，但并发症发生率较高。本研究旨在探讨胰胆管支架置入是否能减轻这些并发症。
本研究采用回顾性观察性分析方法，对在我院接受内镜乳头切除术治疗的 79 例十二指肠乳头腺瘤患者进行了研究。该队列包括未放置支架、单独放置胆管支架、单独放置胰管支架或同时放置胰胆管支架的患者。我们评估了内镜乳头切除术的结果，包括完全切除率和复发率作为主要和次要结局。同时，还分析了并发症的发生率作为安全性结局。
放置支架与不放置支架患者的完全切除率无显著差异（85.7% P 组与 89.2% N-P 组，P=0.64）。各组早期并发症发生率相似。然而，支架组胆管狭窄发生率显著降低（0% B 组与 10.5% N-B 组，P=0.03）。此外，支架放置与随访期间较低的腺瘤复发率相关（2.4% P 组与 16.2% N-P 组，P=0.03；2.4% B 组与 15.8% N-B 组，P=0.04）。
在内镜乳头切除术中放置胰胆管支架可能会降低迟发性并发症的发生率，特别是胆管狭窄的发生率，并降低十二指肠乳头腺瘤的复发率。
本研究得到了北京友谊医院机构审查委员会和伦理委员会的批准（批准号：BFHHZS20230203），并在中国临床试验注册中心进行了回顾性注册（注册号：NCT06301048，初始发布日期：2024 年 2 月 18 日，最后公开发布日期：2024 年 3 月 3 日）。
