Physician-controlled wire-guided cannulation of the minor papilla.

John T Maple,Lilah Mansour,Michael Ansstas,Riad R Azar,Tarek Ammar,Gregory A Coté

doi:10.1155/2010/629308

Abstract

Background. Minor papilla (MiP) cannulation is frequently performed using specialized small-caliber accessories. Outcomes data for MiP cannulation with standard-sized accessories are lacking. Methods. This is a case series describing MiP cannulation outcomes in consecutive patients treated by two endoscopists between July 2005 and November 2008 at two tertiary referral centers. MiP cannulation was attempted using a 4.4 Fr tip sphincterotome loaded with a 0.035″, 260 cm hydrophilic-tip guidewire, using a wire-guided technique under physician control. Results. 25 patients were identified (14 women, mean age 45). Procedure indications included recurrent acute pancreatitis in 16 patients (64%) and chronic pancreatitis in 2 (8%), among other indications. MiP cannulation was successful in 24 patients (96%). Sphincterotomy followed by pancreatic stent placement was performed in 21 patients (84%). Mild post-ERCP pancreatitis occurred in 3 patients (12%). Conclusion. Physician-controlled wire-guided MiP cannulation using a 4.4 Fr sphincterotome and 0.035″ guidewire is an effective and safe technique.

Highlights

Endoscopic access to the dorsal pancreatic duct may be sought in a variety of clinical situations, most commonly in patients with pancreas divisum associated with idiopathic recurrent acute pancreatitis (IRAP) or chronic pancreatitis
When pancreas divisum is suspected prior to the case, dedicated accessories are often selected for Minor papilla (MiP) cannulation, such as needle-tip or highly tapered catheters and small-caliber wires
During cases in which a standard 0.035 platform is already in use, it is unclear whether changing to a small-caliber specialty platform will increase MiP cannulation success

Summary

Introduction

Endoscopic access to the dorsal pancreatic duct may be sought in a variety of clinical situations, most commonly in patients with pancreas divisum associated with idiopathic recurrent acute pancreatitis (IRAP) or chronic pancreatitis. The MiP may be routinely cannulated using a standard pull sphincterotome and 0.035 guidewire, if a wire-guided technique is employed. The objective of our study was to describe the efficacy and safety of MiP cannulation using standard accessories and a wire-guided technique. MiP cannulation was attempted using a 4.4 Fr tip sphincterotome loaded with a 0.035 , 260 cm hydrophilic-tip guidewire, using a wire-guided technique under physician control. Physician-controlled wire-guided MiP cannulation using a 4.4 Fr sphincterotome and 0.035 guidewire is an effective and safe technique

Objectives

Methods

Results

Conclusion