Wire-assisted minor papilla precut papillotomy.

Abstract:

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.

journal_name

Gastrointest Endosc

authors

Wilcox CM,Mönkemüller KF

doi

10.1067/mge.2001.115474

keywords:

subject

Has Abstract

pub_date

2001-07-01 00:00:00

pages

83-6

issue

1

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(01)94991-0

journal_volume

54

pub_type

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