Wire-assisted minor papilla precut papillotomy.

Area of Science:

• Gastroenterology
• Endoscopic retrograde cholangiopancreatography (ERCP)

Background:

• Deep cannulation of the dorsal pancreatic duct in pancreas divisum presents a significant challenge for endoscopists.
• Existing methods may prove insufficient for accessing the dorsal duct, necessitating alternative techniques.

Purpose of the Study:

• To describe a novel technique for facilitating access to the dorsal pancreatic duct in patients with pancreas divisum.
• To evaluate the efficacy and safety of this technique for endoscopic therapy.

Main Methods:

• A prospective study identified patients unable to cannulate the dorsal duct with a standard catheter.
• A needle-knife precut papillotomy was performed at the minor papilla over a guidewire.
• This facilitated passage of diagnostic and therapeutic catheters into the dorsal duct.

Main Results:

• The technique was successfully applied in eleven patients undergoing dorsal ductography for pancreatitis or ductal leak.
• In all cases, the precut papillotomy enabled easy passage of catheters into the dorsal duct for guidewire exchange and stent placement.
• One patient developed pancreatitis, indicating a low complication rate.

Conclusions:

• This precut papillotomy technique provides a reliable method for accessing the dorsal pancreatic duct.
• It utilizes readily available endoscopic accessories, making it a practical option for facilitating endoscopic therapy in pancreas divisum.