Precutting of the Minor Papilla for Pancreatic Duct Cannulation in Pancreas Divisum Patients

Abstract

Therapeutic endoscopic interventions such as pancreatic sphincterotomy of the minor papilla, dilation of the minor papilla, and stent insertion are alternatives to surgical sphincteroplasty in patients with pancreas divisum - particularly in patients with acute recurrent pancreatitis, chronic pancreatitis, and chronic pancreatic pain [1]. Minor papilla sphincterotomy can be carried out using a pull-type sphincterotome or needle-knife sphincterotome, with guidance from a previously inserted stent [1]. Cannulation of the pancreatic duct via the minor papilla is necessary with both of these techniques. Once the pancreatic duct has been cannulated, the procedure can be carried out successfully in almost all patients. The limiting factor in therapeutic endoscopic interventions is cannulation of the minor papilla. Cannulation rates of between 73.5 % and 83.3 % have been reported in several studies [2] [3] [4]. A needle-tipped catheter, a highly tapered catheter, or a guide wire are routinely used for cannulation of the minor papilla [1]. We describe here a technique for cannulation of the minor papilla involving precutting with a needle-knife sphincterotome. So far as we are aware, this technique has not previously been described.