PDF(Pubmed)
Abstract：
Background/Objectives: Endoscopic papillectomy (EP) is the preferred treatment for ampullary tumors because it has fewer side effects than surgical removal. This study retrospectively compared a new anchoring EP method (A-EP) with the conventional (C-EP) approach. Methods: Ninety-nine patients who underwent EP at a single medical institution between 2009 and 2021 were retrospectively reviewed. In all patients, the indications for EP were pathological adenoma with <10 mm of biliary invasion and a tumor diameter <30 mm on endoscopic ultrasonography. The exclusion criteria were antiplatelet/anticoagulant use, previous upper GI surgery, or prior biliary/pancreatic endoscopic therapy. One expert endoscopist performed the two types of EPs, A-EP and C-EP. Results: Sixty-two patients underwent A-EP, and 37 underwent C-EP. There were no significant differences in baseline characteristics, such as sex, age, tumor size, and ductal invasion on endoscopic ultrasound. The A-EP group had higher en bloc resection rates (95.2% vs. 78.4%, p = 0.010). Although the difference was not statistically significant, it tended towards fewer incidences of pancreatitis (p = 0.081) and duct stricture (p = 0.081). The recurrence rate was lower in the A-EP group (8.1% vs. 37.8%, p = 0.000). There were no significant differences between the two groups regarding the follow-up period (A-EP vs. C-EP, 725 vs. 1045 days, p = 0.109) or the days of recurrence (A-EP vs. C-EP, 341 vs. 562 days, p = 0.551). Conclusions: A-EP showed better outcomes than C-EP in terms of en bloc resection and recurrence rates, providing evidence for the efficacy of this novel EP method.
摘要：
背景/目的：内镜乳头切除术（EP）是壶腹肿瘤的首选治疗方法，因为它比手术切除副作用少。这项研究回顾性比较了一种新的锚定EP方法（A-EP）与常规（C-EP）方法。方法：回顾性分析了2009年至2021年在一家医疗机构接受EP的99例患者。在所有患者中，EP的适应症为病理腺瘤，胆管浸润<10mm，内镜超声检查肿瘤直径<30mm。排除标准为使用抗血小板/抗凝剂,以前的上消化道手术，或先前的胆道/胰腺内镜治疗。一位专家内窥镜医师进行了两种类型的EP，A-EP和C-EP。结果:62例患者行A-EP,37例接受了C-EP。基线特征没有显着差异，比如性，年龄,肿瘤大小,和内镜超声检查的导管侵犯。A-EP组的整体切除率较高（95.2％vs.78.4%,p=0.010)。尽管差异没有统计学意义，它倾向于减少胰腺炎（p=0.081）和导管狭窄（p=0.081）的发生率。A-EP组的复发率较低(8.1%vs.37.8%,p=0.000）。两组在随访期间无显著差异（A-EPvs.C-EP,725vs.1045天,p=0.109）或复发天数（A-EP与C-EP,341vs.562天,p=0.551)。结论：就整体切除率和复发率而言，A-EP比C-EP显示更好的结果。为这种新型EP方法的有效性提供了证据。
