Endoscopic pancreatic duct sphincterotomy: Indications, technique, and analysis of results

Kozarek, Richard A.; Ball, Terrance J.; Patterson, David J.; Brandabur, John J.; Traverso, L. William; Raltz, Shirley L.

doi:10.1016/s0016-5107(94)70260-8

Cited by 121 publications

(57 citation statements)

References 24 publications

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“…Placement of a nasopancreatic tube (NPT) or pancreatic stent can reduce this incidence significantly [18] . Restenosis is reported in around 14% of patients on long term follow up [19] . It is believed that restenosis is less common following the longer incision with the pull type as compared to needle knife technique [20] .…”

Section: Cp With Minimal Ductal Changesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention.© 2013 Baishideng. All rights reserved.Key words: Chronic pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatic sphincterotomy; Extracorporeal shockwave lithotripsy; Endosonography Core tip: Chronic pancreatitis is a challenge to the therapeutic endoscopist. A patient with chronic pancreatitis can present with ductal calculi, leaks, pseudocysts, strictures, pancreatic malignancy or a biliary obstruction. Endoscopic therapy offers a high rate of success in properly selected patients. It offers many advantages over surgery, which for a long time was considered the gold standard in the treatment of chronic pancreatitis. This chapter deals with the management of chronic pancreatitis associated strictures, calculi, leaks and pseudocysts. The role of endosonography in management of pseudocysts, cannulation of inaccessible ducts and pain relief has also been discussed.Tandan M, Reddy DN. Endotherapy in chronic pancreatitis.

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Section: Cp With Minimal Ductal Changesmentioning

confidence: 99%

Endotherapy in chronic pancreatitis

Tandan

Reddy²

2013

WJG

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“…When major pain episodes cannot be controlled by major, but acceptable maintenance analgesics, intervals of narcotics, or reasonable and brief periodic hospitalizations, a trial of interventional therapy can be justified. Among three recent studies involving stent therapy in 98 patients, at times associated with other interventional therapies such as lithotripsy and/or sphincterotomy [36][37][38] , two studies [36,38] reported amelioration of pain and one did not [37] . The ideal treatment for patients with pancreaticduct stones, dilated pancreatic ducts, and pain is not known.…”

Section: Endoscopic Therapymentioning

confidence: 99%

Pain management in chronic pancreatitis

Gachago¹,

Draganov²

2008

WJG

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“…Biliary sphincterotomy done immediately before pancreatic sphincterotomy is felt by some to allow for easier identification of clear anatomical landmarks, thus making it a safer and more effective procedure. It may provide better exposure of the pancreaticobiliary septum, and therefore allow improved access to the desired pancreatic tissue [13] . Also, this method of choice prevents the rare possibility of biliary complications following a primary pancreatic cut [1] .…”

Section: Pull-type Sphincterotomymentioning

confidence: 99%

“…Incision length is similar to that of sphincterotomy with a pull-type sphincterotome; that is, the length is generally between 5 mm and 10 mm. Many experts believe that a prior biliary sphincterotomy is especially helpful before utilizing needle-knife technique [13] . Good exposure of the pancreaticobiliary septum allows for better tissue access and more effective 'septotomy'.…”

Section: Needle-knife Sphincterotomymentioning

confidence: 99%

“…Within the last 13 years, there have been four major studies that have examined the rates of complication associated with pancreatic sphincterotomy of the major papilla [14,[44][45][46] . In a study by Kozarek et al [13] , 56 patients underwent EPS. Fifty-four (96%) patients had chronic pancreatitis and two patients had acute recur rent pancreatitis.…”

Section: Complications Of Epsmentioning

confidence: 99%

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Pancreatic sphincterotomy: Technique, indications, and complications

Buscaglia

Kalloo²

2007

WJG

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Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically, its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy: a pull-type sphincterotome technique without prior stent placement, and a needleknife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde cholangio-pancreatography.

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Endoscopic pancreatic duct sphincterotomy: Indications, technique, and analysis of results

Cited by 121 publications

References 24 publications

Endotherapy in chronic pancreatitis

Endotherapy in chronic pancreatitis

Pain management in chronic pancreatitis

Pancreatic sphincterotomy: Technique, indications, and complications

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