Title

Minor papilla endotherapy in patients with ventral duct obstruction: identification and management.

Document Type

Article

Publication Date

2-2017

Institution/Department

Southern Maine Health Care, Gastroenterology

Journal Title

Gastrointestinal Endoscopy

MeSH Headings

Duodenum Anatomy and Histology; Intestinal Obstruction Diagnosis; Human; Intestinal Obstruction Therapy; Disease Management; Pancreas Anatomy and Histology; Catheterization; Academic Medical Centers; Databases; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis Therapy; Pain Therapy; Analgesia; After Care; Record Review; Telephone

Abstract

50% reduction in pain or narcotic analgesia. Follow-up was obtained by chart review and telephone contact. Results Over a 22-year period, 464 patients had minor papilla cannulation. Congenital and incomplete pancreas divisum were excluded, and 64 patients met study criteria. Technical success was achieved in 58 of 64 patients (91%). In patients with stones, 25 of 34 (74%) had clearance using endoscopic techniques. Median follow-up was 15.5 months. Twelve of 28 patients (43%) on chronic narcotic regimens reported a reduction in narcotic use by >50%, and 32 of 44 patients (73%) reached for discussion noted improved abdominal pain by >50%. Thirteen patients required surgery for symptom control. Conclusions In this multicenter experience, 15% of patients undergoing minor papilla cannulation had acquired a ventral PD obstruction. Access via the minor papilla to the upstream main PD for endotherapy and clinical improvement was achieved in most patients. Increased and early recognition of these intensive therapeutic options may enhance treatment options for this complex group of patients."}" data-sheets-userformat="{"2":33569153,"3":{"1":0,"3":1},"10":0,"11":4,"14":[null,2,0],"15":"Calibri","16":11,"28":1}">Background and Aims Pancreatic duct (PD) cannulation via the major papilla may be compromised by downstream obstruction of the ventral PD from a stone or stricture. In patients with a patent accessory PD, cannulation of the minor papilla permits stenting or stone removal upstream of the ventral PD obstruction. Data on this technique are limited. Methods University of Colorado Hospital and Maine Medical Center endoscopy databases were queried for ERCPs with minor papilla cannulation. Technical success was defined as deep cannulation of the minor papilla. Minor papilla endotherapy included sphincterotomy, stricture dilation, stenting, or stone treatment. Clinical improvement was designated as >50% reduction in pain or narcotic analgesia. Follow-up was obtained by chart review and telephone contact. Results Over a 22-year period, 464 patients had minor papilla cannulation. Congenital and incomplete pancreas divisum were excluded, and 64 patients met study criteria. Technical success was achieved in 58 of 64 patients (91%). In patients with stones, 25 of 34 (74%) had clearance using endoscopic techniques. Median follow-up was 15.5 months. Twelve of 28 patients (43%) on chronic narcotic regimens reported a reduction in narcotic use by >50%, and 32 of 44 patients (73%) reached for discussion noted improved abdominal pain by >50%. Thirteen patients required surgery for symptom control. Conclusions In this multicenter experience, 15% of patients undergoing minor papilla cannulation had acquired a ventral PD obstruction. Access via the minor papilla to the upstream main PD for endotherapy and clinical improvement was achieved in most patients. Increased and early recognition of these intensive therapeutic options may enhance treatment options for this complex group of patients.

First Page

365

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