Effect of preventive closure of the frenulum after endoscopic papillectomy: a prospective pilot study.

BACKGROUND AND AIMS: The usefulness of preventive closure of the frenulum after endoscopic papillectomy (EP) could reduce bleeding. The feasibility and safety of clipping was evaluated in this prospective pilot study.

METHODS: This study involved 40 consecutive patients who underwent preventive closure of the frenulum by clipping just after EP. The outcome data were compared with those of the previous 40 patients in whom no preemptive closure had been performed (no-closure group) (UMIN000014783). Additionally, the bleeding sites were examined.

RESULTS: The clipping procedure was successful in all patients. As compared to the no-closure group, the rate of bleeding (p = 0.026) and period of hospital stay (p < 0.001) were significantly reduced in the closure group. There was no difference in the procedure time between the two groups. Furthermore, the incidence rates of pancreatitis and perforation were comparable in the two groups. The bleeding was noted in the frenulum area rather than at any other site in 90.9% of cases.

CONCLUSION: Preventive closure of the frenulum after EP is an effective, safe, rational and economical method to reduce the incidence of delayed bleeding, without prolonging the procedure time, or increasing the risk of post-procedure pancreatitis perforation.