Efficacy of Submucosal Injection in Endoscopic Papillectomy for Ampullary Tumors: A Meta-Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Ampullary adenomas, originating from the ampulla of Vater (AoV), require complete resection due to their precancerous nature. Endoscopic papillectomy offers a less invasive alternative to surgery, but the use of submucosal injection (SI) in this procedure is not standardized, and its efficacy remains unclear due to the unique anatomy of the AoV. This meta-analysis evaluates the clinical efficacy of SI versus no injection before endoscopic papillectomy, focusing on complete resection rates and prevention of complications. Methods: This meta-analysis followed Cochrane and PRISMA guidelines, comparing submucosal injection versus no injection in endoscopic papillectomy for ampullary tumors. We searched PubMed, Embase, Scopus, and Cochrane CENTRAL databases up to May 2024, including RCTs and observational studies. Data extraction followed PICOS criteria using Excel, and statistical analyses were performed with RevMan using a random-effects model (P < 0.05). Results: From 203 screened studies, 4 studies with 322 patients undergoing endoscopic papillectomy were selected. The SI group included 134 patients, while the non-SI group had 116 patients. Primary outcomes assessed included en bloc resection (OR: 1.17; 95% CI: 0.49, 2.77), complete resection (OR: 0.55; 95% CI: 0.27, 1.15), and no evidence of residual tumor after long-term follow-up (OR: 0.55; 95% CI: 0.21, 1.42), with no significant differences between groups. Secondary outcomes showed no significant differences in positive deep resection margin (OR: 1.88; 95% CI: 0.62, 5.73), positive lateral resection margin (OR: 2.19; 95% CI: 0.71, 6.72), and overall positive resection margin (OR: 0.65; 95% CI: 0.19, 2.16). Pathologic findings of adenocarcinoma and adenoma were similar. Adverse events, including post-papillectomy bleeding, pancreatitis, perforation, cholangitis, and papillary stricture, showed no significant differences between the SI and non-SI groups. Conclusion: This meta-analysis provides comprehensive evidence indicating no significant benefit of submucosal injection (SI) over no injection in endoscopic papillectomy for ampullary tumors. The lack of significant differences in en bloc resection, complete resection, absence of residual tumors after long-term follow-up, and adverse events suggests that routine SI in endoscopic papillectomy may not offer additional clinical advantages. Further research and broader clinical evaluations are needed to optimize endoscopic techniques for treating ampullary tumors. (Table Presented).

Volume

119

Issue

10

First Page

S1157

Last Page

S1158

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