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:
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.
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
Research background

Management of recurrent ampullary adenomas after endoscopic papillectomy is still controversial. Some patients have to receive repetitive endoscopic interventions due to the limitations of conventional endoscopic techniques.

Research motivation

Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastrointestinal neoplasms, as well as an appropriate technique for resection locally remnant and recurrent lesions. At present, ESD is rarely used in the treatment of duodenal papillary lesions by duodenoscope due to the complex anatomy of duodenal papilla and technical difficulties.

Research objectives

In this retrospective study, we report our preliminary experience of hybrid ESD by duodenoscope combined with biliary and pancreatic stent placement for recurrent, laterally spreading, duodenal papillary lesions.

Research methods

Two patients with recurrent, laterally spreading, papillary adenomas underwent hybrid ESD by duodenoscope and endoscopic retrograde cholangiopancreatography (ERCP). Outcomes, including endoscopic and histopathological characteristics, time of hybrid ESD and ERCP procedures, en bloc resection, procedure-related complications, and hospital stay were recorded.

Research results

Hybrid ESD using duodenoscope and subsequent biliary and pancreatic stent placement was performed successfully for both patients. The endoscopic size of recurrent papillary lesions was no more than 2 cm. No serious complications occurred during the intraoperative and postoperative periods. Histopathological examination revealed tubulovillous adenoma negative for neoplastic extension at the cut margin in both patients. No recurrence were observed during follow-up.

Research conclusions

Hybrid ESD by duodenoscope is technically challenging, and may be curative for recurrent, laterally spreading papillary adenomas < 2 cm.

Research perspectives

Hybrid ESD by duodenoscope should be performed cautiously in selected patients by experienced endoscopists. A prospective study should be conducted to compare hybrid ESD with conventional endoscopic techniques to gain more evidence.