Wire-assisted minor papilla precut papillotomy
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Published on: February 10, 2015
1Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
Background:
Deep cannulation of the dorsal duct in patients with pancreas divisum may not be possible, even for the experienced endoscopist. This is a description of a technique to facilitate access to the dorsal duct.
Methods:
Patients undergoing dorsal ductography in whom endoscopic therapy was indicated and in whom a 4.5F tapered-tip catheter could not be passed into the dorsal duct over a guidewire were prospectively identified. After ductal opacification, either a 0.035- or 0.021-inch guidewire was passed into the dorsal duct; a needle-knife was then passed to the minor papilla alongside the guidewire, and with appropriate orientation, a precut papillotomy was made.
Results:
Eleven patients undergoing dorsal ductography for recurrent pancreatitis (10 patients) or ductal leak (1 patient) were prospectively treated with the above technique. Secretin was used in 1 patient. In all patients, after precut papillotomy the diagnostic catheter was passed without difficulty into the dorsal duct allowing for guidewire exchange and/or stent placement. Extension of the papillotomy could then be performed with the needle-knife over a pancreatic stent. Complications included pancreatitis in 1 patient.
Conclusions:
This technique, which uses widely available accessories, facilitates access to the dorsal pancreatic duct for endoscopic therapy.
