IDDF2019-ABS-0071 Analysis of the effect of submucosal injection on endoscopic resection of ampullary adenoma

Abstract

Background Endoscopic papillectomy(EP) is currently well accepted for treating ampullary adenoma alternating surgery. Submucosal injection should be performed or not before EP is still uncertain because of the structure and special location of duodenal papilla. Objective To investigate and analyze the effect of EP on submucosal injection of ampullary adenoma. Methods 43 patients who underwent EP at Digestive Endoscopy Center of Beijing Friendship Hospital from September 2012 to January 2018 were retrospectively recruited, including 23 males and 20 females, aged from 28 to 79 years. The patients were subdivided into two groups, 22 patients in the submucosal injection group including 12 males and 10 females, and 21 patients in the control group including 11 males and 10 females. Patient demographics, baseline blood test, tumor characteristics, en bloc resection rate, complete resection rate, complication rate and other endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. Results There were no significant differences in gender (χ2 =0.903, P=0.342), age (t=0.142, P=0.383) and tumor size (t=0.938, P=0.435) between two groups. En bloc resection rate and complete resection rate were 91.67% and 95.83% respectively in the submucosal injection group, and were 80% and 100% in the control group. There were no significant differences with regard to en bloc resection rate (χ2=1.124, P=0.289) and complete excision rate (χ2=0.641, P=0.423) between two groups. No perforation or severe postoperative pancreatitis occurred in all the patients. Intraoperative bleeding occurred in 3 cases (13.6%) of the submucosal injection group and 3 cases (14.3%) of the control group, and 2 cases of hyperamylasemia in the submucosal injection group and none in the control group. No significant differences exist between the two groups according to intraoperative bleeding (χ2=0.006, P=0.940) and hyperamylasemia (χ2=1.318, P=0.251). Conclusions Our data suggest that routine submucosal injection in patients undergoing endoscopic papillectomy may not be necessary and large-scale prospective multicenter randomized studies are required to identify the subgroup of patients who would benefit.