Wire-assisted minor papilla precut papillotomy.

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.