Electric Endocut and Autocut Resection for Endoscopic Papillectomy: A Systematic Review

• Published in: Internal Medicine Vol. 58; no. 19; pp. 2767 - 2772
• Main Authors: Minami, Kazuhiro, Iwasaki, Eisuke, Fukuhara, Seiichiro, Horibe, Masayasu, Seino, Takashi, Kawasaki, Shintaro, Katayama, Tadashi, Takimoto, Youichi, Tamagawa, Hiroki, Machida, Yujiro, Kanai, Takanori, Itoi, Takao
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.10.2019; Japan Science and Technology Agency
• Subjects: Ampulla of Vater - surgery; ampullary tumor; Bleeding; Common Bile Duct Neoplasms - surgery; Electrosurgery - methods; electrosurgical cutting mode; endoscopic papillectomy; Endoscopy; Endoscopy, Digestive System - methods; Humans; Incidence; Internal medicine; Mucosa; Original; Pancreatitis; Systematic review; Treatment Outcome; ampullary tumor; electrosurgical cutting mode; endoscopic papillectomy
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.2720-19

Objective Risks of bleeding and pancreatitis after mucosal resection using the purecut/autocut and blendcut/endocut modes for endoscopic papillectomy have not been fully clarified. Thus, a systematic review on electrosurgical cutting modes for endoscopic papillectomy was conducted focusing on the types and incidence of adverse events. Methods We searched the PubMed and Cochrane library for cases of endoscopic papillectomy recorded as of April 2017. Studies reporting the methods of electrically excising a tumor in the duodenal papilla and the number of adverse events were extracted. Studies were collected and examined separately based on the electrosurgical cutting mode, and the incidence rate for each adverse event was summarized. Results A total of 159 relevant articles were found; among them, 20 studies were included and 139 excluded. Five studies analyzed endoscopic papillectomy with the purecut/autocut mode and 16 with the blendcut/endocut mode. Only one study investigated both modes (purecut and endocut). With the purecut/autocut mode, the incidence of bleeding was 2.8-50%, and that of pancreatitis was 0-50% (mean: 12.8%). With the blendcut/endocut mode, the incidence of bleeding was 0-42.3%, and that of pancreatitis was 0%-17.9% (mean: 9.5%). Conclusion Both methods had high adverse event rates for endoscopic papillectomy. Thus, a standard method of endoscopic papillectomy, including the electrosurgical cutting mode, needs to be established.