Endoscopic sphincterotomy and removal of pancreatic duct stones

Chronic pancreatitis may be associated with pancreatic duct dilatation and ductal stones. Such stones are undoubtedly the result of chronic pancreatitis and stasis within the ductal system and may themselves serve to exacerbate ductal obstruction and recurrent episodes of pancreatitis. Endoscopic sphincterotomy has been used to relieve common duct obstruction secondary to biliary stones. This report suggests that sphincterotomy may also be used to approach selected patients who have pancreatic duct stones and recurrent pancreatitis. The technique involves a preliminary ERCP followed by standard endoscopic sphincterotomy with the papillatome positioned in the bile duct. A balloon catheter is then directed into the pancreatic duct orifice to extract ductal calculi. Although the main duct may be cleared, side branches are more difficult, and perhaps unnecessary, to clear. This method has provided relief of pain in a limited series of patients and may mark the beginning of a more aggressive approach to pancreatic endoscopy.