Prophylactic Closure of Mucosal Defect to Prevent Delayed Bleeding After Endoscopic Papillectomy

Delayed bleeding is a serious complication of endoscopic papillectomy (EP). The aim of this study was to evaluate the efficacy of preventing delayed bleeding of clip after EP.

Consecutive patients diagnosed with ampullary benign tumors who received EP from January 1^st 2013 to December 31^st 2024 were analyzed retrospectively. EP was performed with the snare polypectomy technique. Biliary duct stent and pancreatic duct stent were routinely placed. The resection site is closed completely by clips.

Fifty major papilla benign tumors patients with a mean age of 55.9 ± 10.7 years were found. All of the lesions were En bloc removed in a single endoscopic procedure. The pancreatic duct stents and biliary duct stents were successfully placed in 47 (94%) and 49 patients (98%), respectively. Two patients had positive horizontal margin, 35 patients had negative horizontal margin, and in 13 patients, horizontal margin was compromised by cautery effect. None of the patients had vertical positive margin, 39 patients had vertical negative margin, and in 11 patients, vertical margin was compromised by cautery effect. Post-EP bleeding was observed in 2 patients (4%), which was classified as mild. Post-EP hyperamylasemia was observed in 13 patients (26%), and post-EP pancreatitis was observed in 7 patients (14%), 6 were mild pancreatitis and 1 was severe pancreatitis. Intraoperative perforation occurred in 1 patient, which was clamped with hemostatic clips. No cholangitis was observed. The mean follow-up duration was 378.1 ± 305.7 days. Histologically confirmed recurrence at the resection site was detected in 6 patients (12%).

This study demonstrated that preventive closure of the resection site by clips was technically feasible and effective in preventing delayed bleeding after EP, without increasing the risk of postprocedure pancreatitis and cholangitis.