J. Patterson, L.W. Traverso, Tamara H. Harrison, William M. Spaulding. Background: Endoscopic papillectomy has been associated with short-term cure in.
Abstracts
T1275 Comparison Study Between Covered and Non-Covered Wallstent for Malignant Common Bile Duct Stricture: Efficacy and Complications Pradermchai Kongkam, Rungsun Rerknimitr Introduction: Over the last decade non covered metallic Wallstent has been used as a standard treatment for palliative biliary drainage of malignant biliary obstruction. However, premature Wallstent occlusion by tumor ingrowth still occurs. Therefore, covered Wallstent is designed to prevent tumor ingrowth but the possibility of early migration and tumor overgrowth may happen. Aims: This study was undertaken to evaluate the efficacy and complication of covered Wallstent compared to non covered Wallstent for palliative biliary drainage with malignant common bile duct obstruction. Method: From 01/01 until 07/04, a prospective, randomized, singlecenter study was conducted by using a cohort of 28 pts with malignant distal biliary obstruction at King Chulalongkorn Memorial Hospital. A Wallstent (Microvasive, Natick, MA) was inserted across the stricture into the duct. Pts were evaluated at 1 week and 1 month after Wallstent placement, thereafter, every 3 months. Wallstent occlusions requiring reintervention or patient death with or without preterminal jaundice were defined as Wallstent patency endpoints. Median Wallstent patency time and patient survival time in each group according to the type of Wallstent were estimated with the Kaplan-Meier method and compared by using the log rank test. Result: Mean age of pts in covered Wallstent group (nZ13, M:FZ9:4) and non covered Wallstent group (nZ15, M:FZ6:9) were 68.5(6.2), 65.9(12.0) years, respectively (pZ0.589a). Results are shown in the table. Summary: Initial level of jaundice, post ERCP complications, resolution of jaundice rate, thirty day mortality rate, reintervention rate and median survival time were similar between these two groups. Conclusion: Due to short survival of our pts, the covered Wallstent could not demonstrate the benefit of longer patency over non covered Wallstent. However, Wallstent related complications are low and comparable to non covered Wallstent.
MHO pts were classified as Bismuth 4 obstruction. Five MHO pts (20%) underwent bilateral metallic stent placement. One pt from MHO group had ERCP related perforation of liver capsule and 2 pts from CBO group developed post ERCP pancreatitis. Summary: Mean time for biliary reintervention is longer in CBO group compared to MHO group. Post ERCP cholangitis rate in MHO pts is higher than in CBO pts. Both results are not statistically significant. Complication rate, jaundice resolution rate, thirty-day mortality rate, reintervention rate, median stent patency time and median survival time are not different significantly between these two groups. Conclusion: The out come of biliary drainage for MHO is almost similar to CBO but time for reintervention seems to be shorter in MHO group.
T1277 Papillectomy for Ampullary Neoplasm: Results of a Single Referral Center Richard A. Kozarek, Michael Gluck, John J. Brandabur, David J. Patterson, L.W. Traverso, Tamara H. Harrison, William M. Spaulding
T1276 Outcome of Biliary Drainage by Metallic Stent: Hilar Versus NonHilar Malignant Biliary Obstruction Pradermchai Kongkam, Rungsun Rerknimitr Aims: Generally, malignant hilar obstruction (MHO) is much more difficult to manage by plastic stents than common bile duct obstruction (CBO). The result of metallic stent in CBO is promising. Therefore this study is undertaken to demonstrate the results of metallic stent in MHO compared to CBO. Methods: From 01/01 until 07/04, there were 54 pts underwent metallic biliary stent insertion for malignant biliary obstruction at King Chulalongkorn Memorial Hospital. Pts were divided into two groups, group 1 MHO (nZ 25) (M:FZ14:11), group 2 CBO (nZ 29) (M:FZ19:13) (pZ0.951b). Stent occlusions requiring reintervention or patient death with or without preterminal jaundice were categorized as stent patency endpoints. Median stent patency time and patient survival time in each group according to the type of stricture were estimated with the Kaplan-Meier method and compared by using the log rank test. Results: Mean age of pts in MHO group, CBO group were 61.3(11.3), 66.9(12.2) years, respectively (pZ0.086a). Results of endoscopic biliary drainage, complications, patency time are shown in table. Mean time to biliary reintervention in MHO (nZ7) and CBO groups (nZ5) were 119.2 days and 256.5 days (pZ0.374), respectively. Twenty cases (80%) of
AB210 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
Background: Endoscopic papillectomy has been associated with short-term cure in a significant subset of non-malignant ampullary neoplasms in a recently published multicenter retrospective review. We report the largest single-center experience of pts referred for papillectomy for ampullary neoplasm. Materials and Methods: All pts referred by internal (#10) or external gastroenterologists (#61) for endoscopic resection of ampullary neoplasms between 12/1994-12/2004 were retrospectively reviewed. Data collected included: presence or absence of FAP, clinical presentation, neoplasm location (major/minor ampulla/contiguous juxtampullary area), histology, successful endoscopic removal, concomitant performance of ES and/or PB stent placement, follow-up duration, and need for surgery. Results: 71 pts were referred for endoscopic resection. 60 had endoscopic resection alone, 5 were referred to surgery after biopsy demonstrated invasive malignancy, and 5 pts initially treated endoscopically were referred for subsequent surgery for atypical histology (2), cancer (1), inadequate resection plus additional C-loop adenomas (1), or pt preference (1). 39/71 (56%) had symptoms referable to the adenoma (jaundice, ARP, increased LFTs, pain). 14 were screened for FAP and the remainder were found during evaluation for GERD or dyspepsia. Tumor location was major papilla alone 52, minor papilla alone 6, both 3, and contiguous with the major papilla 13. Papillectomy treatment was completed by laser or APC therapy in 14 pts, and 51 pts (71%) underwent PD and/or CBD ES and 54 (77%) PB stent placement. Complications were noted in 6 pts (8%): 1 mild and 1 moderate acute pancreatitis, 1 acute and 2 delayed bleeds and 1 perforation requiring surgical closure in a pt with lateral extension of the neoplasm. Both cases of pancreatitis occurred before PD stents were regularly placed. Endoscopic resection was effective in 60/71 pts at a mean follow-up of 3.2 years, although residual C-loop adenomas requiring surveillance and treatment have been noted in 2 pts with sporadic adenomas and in 12/14 pts with FAP. Conclusions: 1.) Most ampullary adenomas are endoscopically amenable. 2.) Baseline malignancy and, potentially, the presence of FAP syndrome are associated with need for surgery. 3.) Extensive lateral tumor extension appears to predispose to the risks of perforation and bleeding. 4.) Pancreatitis (and/or cholangitis) can be minimized by PD/CBD ES and/or stent placement.
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