Tu1304 Endoscopic Closure for Prevention of Bleeding After Endoscopic Ampullectomy

Abstract

Endoscopic Closure for Prevention of Bleeding After Endoscopic Ampullectomy Natsuyo Yamamoto*, Hiroyuki Isayama, Yousuke Nakai, Koji Miyabayashi, Suguru Mizuno, Hirofumi Kogure, Takashi Sasaki, Osamu Togawa, Kenji Hirano, Minoru Tada, Kazuhiko Koike Gastroenterology, The University of Tokyo, Tokyo, Japan; Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan Background: Endoscopic resection has been increasingly performed for ampullary tumors as an alternative to radical surgery. Postprocedural complications, such as pancreatitis, bleeding, and biliary stenosis, are the major concerns associated with the endoscopic procedure. Pancreatic stent placement has been proposed to reduce the incidence of postprocedural pancreatitis, but only a few studies have been performed on prevention of postprocedural bleeding. Here, we have investigated the use of endoscopic closure, using clips, after ampullectomy to prevent bleeding. Method: Between 2003 and 2012, 28 pathology-confirmed ampullary adenomas were treated by endoscopic resection, using a snare, at our institute. After hemostasis to control active bleeding, a 5-Fr pancreatic stent was placed. For the 13 adenomas treated after 2009 (clipping [CL] group), each ulcer was partially closed with clips after the resection, regardless of whether active bleeding occurred. The technical success rate of the endoscopic closures was 90% (12/13). The tumor size, duration of the procedure, en bloc and curative resection rates, and rate of early ( 7) complications were compared with those for 15 patients who were treated without endoscopic closure before 2009 (conventional [CV] group). Results: The mean tumor size was larger in the CL group (21.2 mm; range, 9-51 mm) than in the CV group (12.2 mm; range, 7-18 mm). There were no significant differences (CL group vs CV group) in the median duration of the procedures (74 min vs. 81 min), the en bloc resection rates (80% vs 84.6%), or the curative resection rates (86.6% vs 81.8%). Early complications developed in 9 of the 15 (60.0%) patients in the CV group and 2 of the 13 (15.4%) patients in the CL group. Postprocedural bleeding was observed in 4 of the 15 (26.7%) patients in the CV group and in 2 of the 13 (15.4%) patients in the CL group. Pancreatitis occurred in 4 of the 15 (26.7%) patients in the CV group and in 1 of the 13 (7.7%) patients in the CL group. Biliary or pancreatic stenosis was observed only in 1 patient in the CL group. Conclusion: In this retrospective analysis that involved a small number of patients, partial closure after endoscopic ampullectomy reduced the incidence of early complications, especially bleeding; the incidences of pancreatitis and biliary or pancreatic stenosis did not increase.