Clin Endosc.  2012 Sep;45(3):189-193.

Endoscopic Approach via the Minor Papilla for the Treatment of Pancreatic Stones

• Nakazawa T
• Hayashi K
• Naitoh I
• Okumura F
• Joh T

Abstract

BACKGROUND/AIMS
We aimed to evaluate whether the advanced techniques have influenced the minor papilla approach.
METHODS
We studied the success rate of guide wire insertion by using ordinary techniques and advanced techniques (rendezvous method and precut method) in 30 patients via the minor papilla. We compared the selection of the access routes between before (52 patients) and after (28 patients) the introduction of the Soehendra stent retriever.
RESULTS
In 19 out of 30 patients (63%), guide wire insertion via the minor papilla could be achieved by using ordinary techniques. In total, the guide wire could be inserted in 27 patients (90%) by using the advanced techniques. Before introduction of the Soehendra stent retriever, the major papilla approach was chosen in 38 cases (73%), and the minor papilla approach in 14 cases (27%). After introduction of the Soehendra stent retriever, the major papilla approach was used in 26 cases (93%) and the minor papilla in 2 cases (7%). The frequency of selecting the minor papilla approach has significantly decreased (p<0.05).
CONCLUSIONS
The advanced techniques have contributed to the improvement of endoscopic approaches via the minor papilla, and decreased the frequency of selecting the minor papilla approach.

Keyword

Pancreatic stones; Minor papilla; Soehendra stent retriever

MeSH Terms

Humans
Stents

Figure

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  Fig. 1 (A) Guide wire insertion via minor papilla by ordinary approach. (B) Guide wire insertion via minor papilla by advanced approach.

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  Fig. 2 Soehendra stent retriever. (A) A guide wire successfully passed an impacted stone at the head of the pancreas. (B) The Soehendra dilation catheter (4 to 7 Fr) could not pass the stone. (C) The Soehendra stent retriever (7 Fr) could pass the stone easily. (D) A pancreatic stent (7 Fr) could be inserted.

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  Fig. 3 Our strategy for minor papilla approach.

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