Technique of endoscopic papillectomy


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Technique of endoscopic papillectomy

The entire procedure is performed under fluoroscopic guidance using a side-view duodenoscope  with patient under conscious sedation or general anesthesia.

In general, the techniques for ESP is as follows: The papillary tumor is snared at the base, and constant tension is applied to the snare loop during electrosurgery until the lesion is transected. A standard polypectomy snare and blended electrosurgical current (50-60 J) are used.

For lesions not resectable “en bloc” piecemeal polypectomy is used. Aggressive efforts are made to retrieve all resected tissue in all patients for histopathologic evaluation. Endoscopic snare resection is generally performed without submucosal injection. If residual neoplastic tissue remains after snare excision this is fulgurated during the same session by argon plasma coagulation (APC). After papillectomy is advisable implanting a stent into the pancreatic duct to prevent pancreatitis. The stent is generally removed after 4 weeks.

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