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  • Title: Wire-assisted access sphincterotomy of the minor papilla.
    Author: Maple JT, Keswani RN, Edmundowicz SA, Jonnalagadda S, Azar RR.
    Journal: Gastrointest Endosc; 2009 Jan; 69(1):47-54. PubMed ID: 18656861.
    Abstract:
    BACKGROUND: Recommended techniques for minor papilla sphincterotomy include performing a standard pull-type sphincterotomy (PTS) or using a needle-knife over a stent. A wire-assisted access sphincterotomy (WAAS) technique may hold some technical advantages over these accepted methods, but has not been robustly described. OBJECTIVE: To describe the safety and efficacy of WAAS compared with PTS in a series of patients from our institution. DESIGN: Retrospective audit of initial minor papilla sphincterotomies over a 6-year period. Demographic and procedural data were abstracted, and the medical record was reviewed for clinical follow-up. SETTING: A large tertiary referral center. PATIENTS: One hundred twenty-eight consecutive patients with pancreas divisum who underwent ERCPs between April 2001 and April 2007, 64 of whom underwent an initial minor papilla sphincterotomy. INTERVENTIONS: WAAS was performed by deeply cannulating the dorsal duct with a guidewire and then passing a needle-knife sphincterotome alongside the wire and cutting the minor papilla by inserting the needle-knife beside the wire and cutting away from the wire. MAIN OUTCOME MEASUREMENTS: Clinical procedural success and reported adverse events. RESULTS: Thirty-two patients had recurrent acute pancreatitis, 15 had pain only, and 13 had chronic pancreatitis. Thirty-two underwent WAAS, 24 had PTS, and 8 had other types of sphincterotomies. Patients undergoing WAAS (32) versus PTS (24) were similar in age, sex, and procedural indication. Mild post-ERCP pancreatitis and mild intraprocedural bleeding occurred more commonly in the WAAS group, although the differences were not statistically significant. LIMITATIONS: Retrospective, nonrandomized study. CONCLUSIONS: WAAS is an effective technique that may be used either to begin a minor papilla sphincterotomy or to perform the entire sphincterotomy. Complications appear similar to those seen with conventional methods but require a larger patient sample to fully evaluate.
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