Case Report
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Mar 28, 2010; 16(12): 1541-1544
Published online Mar 28, 2010. doi: 10.3748/wjg.v16.i12.1541
Transpapillary incision of refractory circumscript pancreatic duct stricture using wire-guided snare forceps
Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu
Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan
Author contributions: Itoi T performed this procedure; Itoi T, Sofuni A and Itokawa F contributed equally to this work; Kurihara T, Tsuchiya T, Ishii K, Tsuji S and Ikeuchi N collected the data; Itoi T and Moriyasu F wrote this paper.
Correspondence to: Takao Itoi, MD, PhD, Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. itoi@tokyo-med.ac.jp
Telephone: +81-3-33426111 Fax: +81-3-53816654
Received: December 21, 2009
Revised: January 12, 2010
Accepted: January 19, 2010
Published online: March 28, 2010
Abstract

Endoscopic therapy of pancreatic duct (PD) strictures using balloon dilation and pancreatic duct stent (PS) placement has been reported to improve the severity of abdominal pain in selected patients with chronic pancreatitis (CP). However, some strictures are refractory and require frequent PS exchange to control symptoms. We describe two cases of successful endoscopic PD incision for difficult PD stricture using a wire-guided snare. The snare is partially opened within the strictured pancreatic duct while applying current, thus incising the duct. Although both cases were successful without complications we do not advocate that this method be used routinely because of the potential for severe complications, e.g. bleeding, ductal perforation or pancreatic parenchymal damage. In order to prevent these complications, we developed a wire-guided technique under fluoroscopic control. We think this procedure may be useful in patients with short, straight PD strictures. Although further study is required, this approach may have potential for selected patients with refractory PD strictures due to CP.

Keywords: Chronic pancreatitis; Pancreatic duct stricture; Pancreatic duct incision