Fig 1.
Pancreatic duct wire-guided endoscopic papillectomy.
a) Tumor of the papilla prior to the procedure. b) The pancreatic duct was cannulated, and an insulated guidewire was placed. c) An electrosurgical snare was inserted in a monorail fashion over the insulated guidewire, and then the tumor of the papilla was grasped and resected. d) The snare was removed, leaving the specimen intact, and the pancreatic duct was re-cannulated beside the insulated guidewire. e) A normal guidewire was placed into the pancreatic duct. f) A pancreatic stent was placed through this guidewire. g) A snare was inserted in a monorail fashion over the insulated guidewire, and the tip of the guidewire was grasped at the distal end of the specimen. The specimen was then collected with a scope. h) The bile duct was cannulated, and a biliary stent was placed.
Table 1.
Patient characteristics.
Fig 2.
Flowchart indicating the number of participants and complications experienced for each period of time and procedure.
Fig 3.
A patient in whom wire-guided endoscopic papillectomy failed due to a large-sized tumor.
Fig 4.
A patient in whom wire-guided endoscopic papillectomy failed due to technical trouble.
a) Tumor of the papilla prior to the procedure. b) An insulated guidewire was placed into the pancreatic duct, and the papilla was grasped. c) The papilla was resected. d) The snare was detached from the specimen and removed into an endoscope. e) The tumor fell off the endoscope because the snare caught on the insulated guidewire, and then the snare and guidewire came out simultaneously. f) The fallen tumor. Using the net, we collected the tumor with the scope. g) We reinserted the scope and cannulated the pancreatic and biliary ducts. The guidewire was placed in the same manner as that used in conventional endoscopic papillectomy. h) A stent was placed into the pancreatic and biliary ducts.
Fig 5.
The incidence of pancreatitis according to the success or failure of pancreatic duct stenting.
Fig 6.
Comparisons of the rates of pancreatic duct stenting (a) and post-EP pancreatitis (b) before and after the introduction of the wire-guided method.
WGEP: wire-guided endoscopic papillectomy; EP: endoscopic papillectomy.