Effectiveness of Endoscopic Papillectomy With Stent for Treating Duodenal Papillary Adenoma

Duodenal papillary adenoma, a potentially malignant benign tumor is primarily treated with endoscopic papillectomy. Despite its efficacy, endoscopic papillectomy has a high complication rate. This study investigates whether pancreatic duct and common bile duct stent placement can mitigate these complications. In a retrospective analysis, 79 patients with duodenal papillary adenoma, treated with endoscopic papillectomy at our center, were studied. The cohort included patients who underwent endoscopic papillectomy with no stents placement, common bile duct stent placement alone, pancreatic duct stent placement alone, or stents placement in both ducts. Complete resection rates did not significantly differ between patients with or without stent placement. Early complication rates were similar across groups. However, significant reduction in common bile duct stenosis was observed in the stenting group. Furthermore, stent placement correlated with lower adenoma recurrence rates during follow-up. Thus, Pancreatic duct and common bile duct stent placement in endoscopic papillectomy may decrease late complications, particularly common bile duct stenosis, and reduce the recurrence of duodenal papillary adenoma.

Inclusion criteria

• Age ≥18 years.
• Identification of duodenal papillary lesions via gastroscopy or duodenoscopy.
• Intraductal involvement <20mm.
• Absence of preoperative peripheral lymph node metastasis and pancreatic/biliary duct stenosis (verified by CT, MRI, or other imaging).
• Postoperative biopsy confirming adenoma.

Exclusion criteria

• Diagnosis of familial adenomatous polyposis or multiple hamartoma syndrome.
• Patients undergoing pancreaticoduodenectomy within a month post-EP for residual lesions.