An improved technique for accessory papilla cannulation in pancreas divisum

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Pancreaticobiliary Medicine

Background:

• Pancreas divisum is a common congenital anomaly of the pancreatic duct system.
• Cannulation of the dorsal pancreatic duct via the accessory papilla can be challenging.
• Accurate visualization of the dorsal pancreas is crucial for diagnosis and management.

Purpose of the Study:

• To evaluate the success rate of accessory papilla cannulation in patients with pancreas divisum.
• To identify methods to improve cannulation success when the main papilla approach is unsuccessful.

Main Methods:

• Dorsal pancreas ductography was performed in 15 consecutive patients with pancreas divisum.
• Accessory papilla cannulation was attempted in all cases.
• Intravenous secretin and a 23-gauge needle catheter were utilized when needed.

Main Results:

• Successful cannulation of the accessory papilla was achieved in 13 out of 15 cases (86.7%).
• The use of intravenous secretin and a fine-gauge needle catheter facilitated cannulation in challenging cases.
• Complete dorsal pancreas pancreatograms were obtained in successful cannulation cases.

Conclusions:

• Accessory papilla cannulation is a feasible technique for dorsal pancreas ductography in pancreas divisum.
• Specific techniques, including secretin stimulation and specialized catheters, enhance success rates.
• This method provides valuable diagnostic information when standard approaches fail.