Premium
External drainage of bile and pancreatic juice after endoscopic submucosal dissection for duodenal neoplasm: Feasibility study (with video)
Author(s) -
Fukuhara Seiichiro,
Kato Motohiko,
Iwasaki Eisuke,
Machida Yujiro,
Tamagawa Hiroki,
Kawasaki Shintaro,
Sasaki Motoki,
Kiguchi Yoshiyuki,
Takatori Yusaku,
Matsuura Noriko,
Nakayama Atsushi,
Ogata Haruhiko,
Kanai Takanori,
Yahagi Naohisa
Publication year - 2021
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13907
Subject(s) - medicine , endoscopic submucosal dissection , pancreatitis , perforation , adverse effect , surgery , pancreatic abscess , endoscopic retrograde cholangiopancreatography , endoscope , endoscopy , abscess , bile duct , therapeutic endoscopy , gastroenterology , materials science , punching , metallurgy
Background and Aims Endoscopic submucosal dissection (ESD) for superficial duodenal epithelial tumors (SDETs) is technically difficult and has a high risk of adverse events. Endoscopic nasobiliary and nasopancreatic duct drainage (ENBPD) may reduce the risk of delayed adverse events by preventing exposure of the post‐ESD mucosal defect to bile and pancreatic juice. This study was performed to evaluate the safety and feasibility of ENBPD after duodenal ESD. Methods Patients who underwent ESD for SDETs from July 2010 to March 2020 were included. We collected data on the success rate of ENBPD, adverse events due to insertion of a side‐viewing endoscope, and pancreatitis after ENBPD. We also collected the clinical outcomes of duodenal ESD, including the incidence rate of delayed adverse events (defined as bleeding or perforation found after the endoscopic procedure). Results Among 70 patients without complete closure of the post‐ESD mucosal defect, ENBPD was successfully performed in all 25 patients including 21 cases inserted immediately after ESD and four cases inserted later. There were no adverse events associated with ENBPD procedure intraoperatively, while pancreatitis after ENBPD occurred in four patients (16.0%). No patients who underwent immediate ENBPD required intervention for an intra‐abdominal abscess or delayed perforation, whereas 3 of 49 patients (6.1%) who did not undergo immediate ENBPD required surgery or drainage of an abscess. Conclusions Endoscopic nasobiliary and nasopancreatic duct drainage is technically feasible and might provide effective prophylaxis for delayed adverse events, even if a large mucosal defect is present after ESD.