Eight-Year Study of Pancreatitis and Sphincterotomy

Drainage operations in chronic pancreatitis

“…Transduodenal (biliary) sphincterotomy was proposed by Doubilet and Mulholland in 1956 on the basis that pancreatitis was caused by bile reflux2', but the operation has not stood the test of time. A more logical procedure is to divide or excise the septum between the bile duct and major pancreatic duct, thus relieving obstructive pancreatopathy in the ampullary region23.…”

Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: Three-year follow-up of exocrine pancreatic function and clinical symptoms

“…This is remarkable because pancreatobiliary drainage by endoscopic placement of an endoprothesis (needing exchange of stents at intervals of 2 to 4 mo) is accompanied with complications and shows poor long-term results [15,16] . Since papillary stenosis has been suggested to play a possible role as a pathogenetic factor in pancreatitis [6,17,18] , the present study included patients with pancreatitis type symptoms and focused on changes in exocrine pancreatic function. Therapeutical approaches in patients with chronic pancreatitis aim to alleviate pain, prevent attacks of pancreatitis, reduce the effects of pancreatic insufficiency and manage complications no matter what the etiology of chronic pancreatitis might be.…”

Pancreatic sphincterotomy and sphincteroplasty.

“…4 Believing that outflow obstruction was more important than reflux, Bartlett and Nardil extended the operation by dividing the common septum between the terminal bile duct and pancreatic duct, thereby achieving a pancreatic sphincterotomy in addition. Subsequently, Moody and colleagues actually excised this common septum (transampullary septectomy or extended papilloplasty) in 92 patients with disabling post cholecystectomy pain, 85 of whom were found to have stenosis of the origin of the duct of Wirsung.67 We have recently undertaken a modified pancreatic sphincteroplasty in a small series of patients with pancreatic or papillary disease.8 The first endoscopic cannulation of the papillar of Vater by McCune in 1968 opened a new era in the diagnostic approach to pancreatobiliary disorders.9 Six years later this purely diagnostic technique was adapted to become a therapeutic modality by the introduction of endoscopic biliary sphincterotomy," followed by other treatment modalities including pancreatic sphincterotomy.…”