Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2020; 26(37): 5673-5681
Published online Oct 7, 2020. doi: 10.3748/wjg.v26.i37.5673
Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions
Zi-Kai Wang, Fang Liu, Yun Wang, Xiang-Dong Wang, Ping Tang, Wen Li
Zi-Kai Wang, Fang Liu, Xiang-Dong Wang, Ping Tang, Wen Li, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Yun Wang, Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, Beijing, China
Author contributions: Wang ZK and Liu F contributed equally to this manuscript; Li W and Wang ZK completed study conception and design, endoscopic operation; Wang ZK and Liu F wrote and edited the manuscript; Wang Y finished pathological analysis; Wang ZK, Liu F, Wang XD, and Tang P completed endoscopic operation, data analysis and interpretation.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the PLA General Hospital, No. s2019-274-01.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen Li, MD, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. liwen2000@yahoo.com
Received: June 15, 2020
Peer-review started: June 15, 2020
First decision: July 25, 2020
Revised: August 8, 2020
Accepted: September 12, 2020
Article in press: September 12, 2020
Published online: October 7, 2020
Processing time: 104 Days and 22.9 Hours
Abstract
BACKGROUND

The management strategies for recurrent ampullary adenoma after endoscopic papillectomy are still controversial. Patients with the recurrent papillary lesions need to receive repetitive endoscopic interventions due to the limitations of conventional endoscopic techniques.

AIM

To assess the feasibility, efficacy, and safety of hybrid endoscopic submucosal dissection (ESD) by duodenoscope for recurrent, laterally spreading papillary lesions.

METHODS

We enrolled two patients with recurrent, laterally spreading, duodenal papillary adenomas with no intraductal extension confirmed by follow-up between March 2017 and September 2018. After marking the resection borders of the lesion using a dual knife, a submucosal cushion was created by injecting a mixture of saline solution, methylene blue, and adrenaline. A total circumferential incision and submucosal excision was performed by dual knife combined with insulated-tip diathermic knife, and then the lesion was ligated and resected using an electric snare. Endoscopic hemostasis was applied during the endoscopic procedures. Moreover, the endoscopic retrograde cholangiopancreatography (ERCP) procedures, including selective cannulation and stent implantation of biliary and pancreatic ducts, were performed. Additionally, we performed endoclip closure for mucosal defect after ESD.

RESULTS

Hybrid ESD using a duodenoscope and biliary and pancreatic stent placement were performed successfully in two patients. The endoscopic size of recurrent papillary lesions was no more than 2 cm. Generally, the average total procedure time was 95.5 min, and the procedure time of ESD and ERCP was 38.5 min and 15.5 min, respectively. No serious complications occurred during the intraoperative and postoperative periods. The histopathological examination revealed tubulovillous adenoma negative for neoplastic extension at the cut margin in both patients. The duodenoscopic follow-up and histopathology of biopsy specimens at 3 mo after ESD showed no residual or recurrent lesions in ampullary areas in both cases. Both cases have been followed up with no recurrence to June 2020.

CONCLUSION

Hybrid ESD by duodenoscope is technically challenging, and may be curative for recurrent, laterally spreading papillary adenomas < 2 cm. It should be performed cautiously in selected patients by experienced endoscopists.

Keywords: Endoscopic submucosal dissection; Ampullary adenoma; Recurrent; Laterally spreading; Papillary lesions

Core Tip: The management strategies for recurrent ampullary adenomas after endoscopic papillectomy are still controversial. Our preliminary experience showed that hybrid endoscopic submucosal dissection by duodenoscope could be feasible for recurrent, laterally spreading ampullary adenomas. Follow-up after hybrid endoscopic submucosal dissection showed no residual or recurrent lesions in ampullary areas. However, it should be performed with caution by experienced endoscopists in selected patients, and the effectiveness should be verified by large-scale studies.