Copyright
©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2013; 5(3): 81-88
Published online Mar 16, 2013. doi: 10.4253/wjge.v5.i3.81
Endoscopic approach through the minor papilla for the management of pancreatic diseases
Nao Fujimori, Hisato Igarashi, Akira Asou, Ken Kawabe, Lingaku Lee, Takamasa Oono, Taichi Nakamura, Yusuke Niina, Masayuki Hijioka, Masahiko Uchida, Kazuhiro Kotoh, Kazuhiko Nakamura, Tetsuhide Ito, Ryoichi Takayanagi
Nao Fujimori, Hisato Igarashi, Akira Asou, Lingaku Lee, Takamasa Oono, Taichi Nakamura, Yusuke Niina, Masayuki Hijioka, Masahiko Uchida, Kazuhiro Kotoh, Kazuhiko Nakamura, Tetsuhide Ito, Ryoichi Takayanagi, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
Ken Kawabe, Department of Gastroenterology, National Hospital Organization, Kyushu Medical Center, Chuou-ku, Fukuoka 810-8563, Japan
Author contributions: Fujimori N, Igarashi H, Ito T, Kawabe K, Oono T, Kotoh K, Nakamura K and Takayanagi R designed research; Fujimori N, Igarashi H and Kawabe K performed endoscopic procedures; Fujimori N, Asou A, Lee L, Nakamura T, Niina Y, Hijioka M, and Uchida M performed research; Fujimori N and Igarashi H analyzed data; Fujimori N, Igarashi H and Ito T wrote the paper.
Supported by (In part) the Research Committee of Intractable Diseases of the Pancreas (principal investigator: Tooru Shimosegawa) provided by the Ministry of Health, Labour and Welfare Japan
Correspondence to: Tetsuhide Ito, MD, PhD, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. itopapa@intmed3.med.kyushu-u.ac.jp
Telephone: +81-92-6425285 Fax: +81-92-6425287
Received: June 29, 2012
Revised: November 8, 2012
Accepted: January 23, 2013
Published online: March 16, 2013
AIM: To clarify the efficacy and safety of an endoscopic approach through the minor papilla for the management of pancreatic diseases.
METHODS: This study included 44 endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in 34 patients using a minor papilla approach between April 2007 and March 2012. We retrospectively evaluated the clinical profiles of the patients, the endoscopic interventions, short-term outcomes, and complications.
RESULTS: Of 44 ERCPs, 26 were diagnostic ERCP, and 18 were therapeutic ERCP. The most common cause of difficult access to the main pancreatic duct through the major papilla was pancreas divisum followed by distortion of Wirsung’s duct. The overall success rate of minor papilla cannulation was 80% (35/44), which was significantly improved by wire-guided cannulation (P = 0.04). Endoscopic minor papillotomy (EMP) was performed in 17 of 34 patients (50%) using a needle-knife (13/17) or a pull-type papillotome (4/17). EMP with pancreatic stent placement, which was the main therapeutic option for patients with chronic pancreatitis, recurrent acute pancreatitis, and pancreatic pseudocyst, resulted in short-term clinical improvement in 83% of patients. Mild post-ERCP pancreatitis occurred as an early complication in 2 cases (4.5%).
CONCLUSION: The endoscopic minor papilla approach is technically feasible, safe, and effective when the procedure is performed in a high-volume referral center by experienced endoscopists.
