Abstract

Research Article

Endoscopic treatment of pancreatic diseases via Duodenal Minor Papilla: 135 cases treated by Sphincterotomy, Endoscopic Pancreatic Duct Balloon Dilation (EPDBD), and Pancreatic Stenting (EPS)

Tadao Tsuji*, G Sun, A Sugiyama, Y Amano, S Mano, T Shinobi, H Tanaka, M Kubochi, K Ohishi, Y Moriya, M Ono, T Masuda, H Shinozaki, H Kaneda, H Katsura, T Mizutani, K Miura, M Katoh, K Yamafuji, K Takeshima, N Okamoto, Y Hoshino, N Tsurumi, S Hisada, J Won, T Kogiso, K Yatsuji, M Iimura, T Kakimoto and S Nyuhzuki

Published: 08 July, 2019 | Volume 3 - Issue 1 | Pages: 012-019

Treatments via the minor papilla is effective where the deep cannulation via the major papilla is impossible in such cases as [1] the Wirsung’s duct is inflammatory narrowed, bent or obstructed by impacted stones [2] pancreatic duct divisum (complete or incomplete) [3], maljunction of pancreatico-biliary union with stones [4], pancreatic stones in the Santorini’s duct. In [1,2] cases, the pancreatic juice flow via the major papilla decreases, while that of the minor papilla increases. Then the size of minor papilla and its orifice shows corresponding enlargement. This substitutional mechanism is an advantage when undertaking our new method. Since the pancreatic juice flow is maintained via the minor papilla in these cases, accurate and careful endoscopic skills are necessary to prevent pancreatitis due to the occlusion of the Santorini’s duct after this procedure. We have experienced 135 cases treated via minor papilla in these 27 years, so we would like to report about its safety and efficacy.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001009 Cite this Article Read Full Article PDF

Keywords:

Minor Duodenal Papilla; Pancreatic Divisum; EPST; EPDBD-Endoscopic Pancreatic Duct Balloon Dilation; EPS; Pancreatic Stone; Pancreatic pseudocyst

References

  1. Tsuji T. et al. Treatment of Pancreatic diseases via duodenal minor papilla. Endoscopic treatment of bile duct and pancreas. Medical View. 2007; 158-165.
  2. Tsuji T. et al. Endoscopic approach-endoscopic treatment of pancreatic diseases via duodenal minor papilla Hepato-Biliary-Pancreaic Imaging. 2009; 11: 205-213.
  3. Tsuji T. et al. The status and the prognosis of 225 cases of pancreatic stones in our hospital. Pancreas. 2009; 24: 62-73.
  4. Tsuji T. et al. Treatment of Pancreatic diseases via duodenal minor papilla. Tan to Sui. 2009; 30: 1187-1194.
  5. Tsuji T. et al. Endoscopic treatment of pancreatic diseases via duodenal minor papilla. Tan to Sui. 2012; 33: 995-1003.
  6. Tsuji T. et al. Treatment of Pancreatic diseases via duodenal minor papilla. Tan to Sui. 2012; 30: 1187-1194.
  7. Tsuji T. et al. Endoscopic treatment of pancreatic diseases via duodenal minor papilla. Tan to Sui. 2014; 35: 249-256.
  8. Tsuji T. et al. 628 cases of pancreatic diseases treated by EPDBD (Endoscopic Pancreatic Duct Balloon Dilation)–its usefulness and safety. Liver and Pancreatic Sciences. 2017; 2: 1-9.
  9. Inui K, Tazuma S, Yamaguchi T, Ohara H, Tsuji T, et al. Treatment ofPancreatic Stones with Extracorporeal Shock Wave Lithotripsy Results of a Multicenter Survey. Pancreas. 2005; 30: 26-30. PubMed: https://tinyurl.com/yxqmeezr
  10. Suzuki Y, Sugiyama M, Inui K, Igarashi Y, Ohara H, et al. Management for Pancreatolithiasis A Japanese Multicenter Study. Pancreas. 2013; 42: 584-588. PubMed: https://tinyurl.com/y4ttygzo
  11. Kamisawa TY, Egawa. Size, location and patency of the minor duodenal papilla as determined by dye-injection endoscopic retrograde pancreatography. Dig Endosc. 2001; 13: 82-85.
  12. Kamisawa T. Clinical Significance of the minor duodenal papilla and accessory pancreatic duct. Journal of Gastroenterology. 2004; 39: 605-615. PubMed: https://tinyurl.com/yxq2wh75
  13. Cotton PB. Duodenoscopic papillotomy at the minor papilla for reccurent dorsal pancreatitis. Endoscop Digest. 1978; 3: 27-28.
  14. Cotton PB. Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis. Gut. 1980; 21: 105-114. PubMed: https://tinyurl.com/yxvts63o
  15. Russel RCG, Wong NW, Cotton PB. Accessory sphincterotomy endoscopic and surgical in patient with pancreas divisum. Br J Surg. 1984: 71: 954-957. PubMed: https://tinyurl.com/y5x28n8b
  16. Soehendra N, Kempeneers I, Nam VC, Grimm H. Endoscopic dilation and papillotomy of the accessory papilla and internal drainage in pancreas divisum. Endoscopy. 1986; 18: 129-132. PubMed: https://tinyurl.com/y67mmqt9
  17. Lans JI, Geenen JE, Johanson JF, Hogan WJ. Endoscopic therapy in patient with pancreas divisum and acute pancreatitis; a prospective, randomized, controlled clinical trial. Gastrointest Endosc. 1992; 38: 430-434. PubMed: https://tinyurl.com/y4nckq7t
  18. Lehman GA, Sherman S, Nisi R, Hawes RH. Pancreas divisum;results of minor papilla sphincterotomy. Gastrointest Endosc. 1993; 39: 1-8. PubMed: https://tinyurl.com/y42xyk7n
  19. Heyries L. Long term results of endoscopic management of pancreas divisum with reccurent acute pancreatitis. Gastrointest Endosc. 2002; 55: 376-381.
  20. Coleman SD. Endoscopic Treatment in Pancreas Divisum. The American Journal of Gastroenterology. 1994; 89: 8.
  21. Fukumori D, Ogata K, Ryu S, Maeshiro K, Ikeda S. An Endoscopic Sphincterotomy of the Minor Papilla in the management of Symptomatic Pancreas Divisum. Hepato-Gastoenterology. 2007; 54: 561-563. PubMed: https://tinyurl.com/y2pmy39r
  22. Cohen SA, Rutkovsky FD, Siegel JH, Kasmin FE. Endoscopic stenting and sphincterotomy of the minor papilla in symptomatic pancreas divisum: Results and complications. Diagn Ther Endosc. 1995; 1: 131-139. PubMed: https://tinyurl.com/yy95vxfs
  23. Cohen SA. A new technique of minor papilla sphincterotomy in pancreas divisum. Precut needle-knife sphincterotomy of the minor papilla in pancreas divisum. Gastrointest Endosc. 1997; 45: 155.
  24. Renzulli P, Müller C, Uhl W, Scheurer U, Büchler MW. Impacted papilla minor stone in pancreas divisum causing severe acute pancreatitis: A case for early ERCP in acute pancreatitis of unknown origin. Digestion. 1999; 60: 281-283. PubMed: https://tinyurl.com/y5t6qvuq
  25. Kinukawa K. A clinical Study of the Minor Duodenal Papilla - A Trial of the Endoscopic Papillotomy of the Minor Duodenal Papilla. Gastroenterological Endoscopy. 1986; 28.
  26. Arisaka Y. Endoscopic Retrograde Pancreatography via Duodenal Accessory Papilla. Tan to Sui. 2008; 29: 991-998.
  27. Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, et al. Meandering Main Pancreatic Duct as a Relevant Factor to the Onset of Idiopathic Reccurent Acute Pancreatitis. 2012; l7: e37652. PubMed: https://tinyurl.com/yygghvbt
  28. Koshida S. Cannulation of the Minor Papilla. Tan to Sui. 36: 925-9282015; 36: 925928.
  29. Ghattas G, Deviere J, Blancas JM, Baize M, Cremer M. Pancreatic rendezvous. Gastrointest Endosc. 1992; 38: 590-594. PubMed: https://tinyurl.com/y249m7xd
  30. Maguchi H. Approach Techniques for Pancreatic Duct in Diffi cult Cases- Rendezvous Technique and Dilation Technique of the Pancreatic Duct Stricture using a Stent Retriever. Tan to Sui. 2009; 30: 1195-1198.
  31. Sherman S, Lehman GA. Endoscopic Pancreatic sphincterotomy; t echniques and complications. Gastrointest Endosc Clin N Am. 1998; 8: 115-1124. PubMed: https://tinyurl.com/y26o4e
  32. Song MH, Kim MH, Lee SK, Lee SS, Han J, et al. Endoscopic minor papilla interventions in patients without pancreas divisum. Gastrointestinal endoscopy. 2004; 59: 901-905. PubMed: https://tinyurl.com/y47njsau
  33. Wilcox CM, Mönkemüller KF. Wire assited minor papilla –precut papillotomy. Gastrointestinal Endoscopy. 2001; 54; 83-86. PubMed: https://tinyurl.com/y347b65l  
  34. Kikuyama M. Pancreatic Duct Stenting Via the duodenal Minor Papilla. Tan to Sui. 2008; 29: 1009-1015.
  35. Kozarek RA. Endoscopic approach to pancreas divisum. Dig Dis Sci. 1995; 40: 1975-1981.
  36. Watkins JL, Lehman GA. Minor papilla sphincterotomy Chapter 15) ERCP 143-151.Saunders Elsevir Philadelphia 2008.
  37. Inui K. Endoscopic Approach via the Minor Duodenal papilla. Digestive Surgery. 2010; 27: 153-156.

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