| Objective:To evaluate the efficacy and safety of endoscopic papillectomy of major duodenal papilla neoplasms.Methods:We retrospectively reviewed and analyzed the clinical and pathological data,postoperative outcomes and complications of 23 patients who underwent endoscopic papillectomy of major duodenal papilla neoplasms in the Department of Endoscopy,from October 2015 to January 2021.Results:Endoscopic papillectomy of major duodenal papilla neoplasms was successfully performed in 23 patients.The size of resected lesions varied between 0.5-2.8 cm.Among them,21 patients were conducted en bloc resection procedure and 2 patients were received piecemeal resection.Postoperative complications occurred in 11 patients,the incidence rate was 47.8%(11/23),of which 6 patients had two or more complications.Postoperative bleeding occurred in 8 patients(34.8%),among which five patients stopped bleeding after endoscopic hemostasis and three patients stopped after interventional embolization.Perforation occurred in 2 cases(8.7%),and healed after conservative treatment such as anti-inflammatory treatment and abdominal drainage.Five patients had pancreatitis(21.7%)and recovered after treatment with somatostatin and rectal administration of indomethacin.Preoperative biopsy showed high-grade intraepithelial neoplasia in 11 cases,low-grade intraepithelial neoplasia in 10 cases and chronic inflammation in 2 cases;Postoperative pathological results suggested that 4 cases were adenocarcinoma and 19 cases were adenoma.The coincidence rate of results between preoperative biopsy and postoperative pathology was 39.1%(9/23),and 12 cases(52.2%)were underestimated and 2 cases(8.7%)were overestimated.The prognosis of all patients was good,and there was no death event during the follow-up period(follow-up was 4-55 months).Conclusion:Major duodenal papilla neoplasms with early stage should be treated with relatively aggressive resection.Endoscopic resection of duodenal papillary tumor is safe and effective in the short term,and can be recommended as the first choice.However,the long-term effect still needs to be validated by multi-centered and prospective studies.Objective:To compare the clinical effect of three types of plastic biliary stent in relieving obstructive jaundice caused by unresectable hilar cholangiocarcinoma.Methods:This was a retrospective study.We enrolled 61 patients with obstructive jaundice caused by unresectable hilar cholangiocarcinoma from April 2014 to December 2020.Plastic biliary stent placement was used to relieve jaundice,including 18 cases of intragastric indwelling at the end of biliary stent,31 cases of duodenal indwelling at the end of biliary stent,12 cases of duodenal indwelling at the level of biliary stent.The clinical efficacy and complications were followed up and the results were analyzed.Results:There was no significant difference in median age(p=0.076).There was also no statistically difference in the median stent patency period(p=0.101),90-day obstruction rate(p=0.589),peri-operative mortality(p=1)among three patient groups.However,the fever rate within 2 weeks of the three groups were significantly different(p=0.003 respectively).Conclusion:There was no significant difference in median age,90-day obstruction rate,median stent patency period and peri-operative mortality among three patient groups.Patients with biliary plastic stents with ends placed at the horizontal portion of the duodenum had a lower fever rate within two weeks after implantation period compared with the two other groups.Therefore,biliary plastic stents with ends placed at the horizontal portion of the duodenum should be recommended as the preferred procedure.However,the current analysis is limited in sample size,and multi-center randomized controlled trials need to be conducted to further verify our conclusion. |
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