• Journal of Digestive Cancer Research
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• v.11 no.2
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• pp.93-98
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• 2023

Ampullary tumor is a rare disease whose prevalence rate has increased gradually in recent years with the increase in endoscopic examinations. Ampullary lesions are observed via endoscopy, and biopsy is done to determine whether such lesions are adenomas or carcinomas. Endoscopic papillectomy is performed on ampullary adenomas without intraductal lesions. Before the procedure, bleeding tendencies and pancreatitis are assessed, and the lesion is resected using a high-frequency wave and a thin wire snare. Thereafter, pancreatic duct stent insertion or clipping of the resection site is performed to prevent postprocedural pancreatitis. Although 47-93% of the patients achieve complete endoscopic papillary resection, the recurrence rate is 5-31%. Hence, regular follow-up via endoscopy is required.

• Clinical Endoscopy
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• v.56 no.6
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• pp.802-811
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• 2023

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions: cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.