Abstract
Acute pancreatitis (AP) is a common adverse event (AE) of endoscopic papillectomy (EP). Prophylactic plastic pancreatic stent (PPS) placement appears to prevent AP. We evaluated factors associated with post-EP AP by a retrospective analysis of patients with tumors of the duodenal papilla who underwent EP from January 2008 to November 2016 at 2 tertiary care centers. Clinical, laboratory, endoscopic ultrasound parameters, and PPS placement were evaluated. Seventy-two patients underwent EP (37 men), with mean age of 60.3 (31–88) years. Mean main pancreatic duct (MPD) diameter was 0.44 (0.18–1.8) cm. Mean tumor size was 1.8 (0.5–9.6) cm. Tumors were staged as uT1N0, uT2N0, and uT1N1 in 87.5%, 11.1%, and 1.4%. Thirty-eight AEs occurred in 33 (45.8%) patients, with no mortality. Total bilirubin, tumor size, MPD diameter, and PPS placement had odds ratios (ORs) of 0.82, 0.14, 0.00, and 6.43 for AP. Multivariate analysis (PPS placement × MPD diameter) showed ORs of 4.62 (95%CI, 1.03–21.32; p = 0.049) and 0.000 (95%CI, 0.00–0.74; p = 0.042) for AP. In conclusion, patients with jaundice, large tumors, and dilated MPD seem less likely to have post-EP AP. PPS placement was associated with a higher risk of AP, which may question its use.
Highlights
Tumors of the duodenal papilla (DP) account for 0.2 to 5% of all gastrointestinal neoplasms, and carcinoma is the most common neoplasm of the small intestine[1]
The present study was designed to evaluate factors associated with the occurrence of Acute pancreatitis (AP) in a controlled group of patients with tumors of the DP subjected to endoscopic papillectomy (EP)
Papillary tumors were an incidental finding during digestive endoscopy with bulging of the papillary region or some mucosal irregularities in 22 cases (30.5%)
Summary
Tumors of the duodenal papilla (DP) account for 0.2 to 5% of all gastrointestinal neoplasms, and carcinoma is the most common neoplasm of the small intestine[1]. Prophylactic PPS placement appears to prevent obstruction of the pancreatic flow secondary to edema that is caused in the region by tumor resection using electrocautery. Studies addressing this issue are still scarce, and many of them have produced conflicting results[7,11,12]. The TN staging of papillary tumors is effective and, along with the investigation of the common bile duct (CBD) and the main pancreatic duct (MPD), reinforces the indication for EP by accurately showing that the tumor is confined to the papilla[13,14,15,16,17]. UT1 Tumor limited to the duodenal papilla yes uT2 Tumor invading the duodenal wall yes uT3
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