Pancreatic sphincterotomy

Abstract

Since 1985 pancreatic sphincterotomy was used with therapeutic purpose itself or as a “gateway” for pancreatic duct treatments. Indications include: treatment of chronic pancreatitis (e.g., papillary stenosis, before stent placement or stone removal), recurrent pancreatitis in pancreas divisum (with or without santorinicele), sphincter of Oddi dysfunction (type I or II), pancreatic fistula, diagnostic or therapeutic pancreatoscopy, and IPMN-associated recurrent pancreatitis (very selected cases). The procedure can be performed both at the minor and at the major papilla, depending on ductal anatomy, and in the latter case can be associated with biliary sphincterotomy. Pancreatic sphincterotomy is performed in a similar fashion to the biliary one, generally employing the same devices. Guidewired deep cannulation of the main pancreatic duct is mandatory before sphincterotomy. The procedure is considered to be at risk for the development of post-ERCP pancreatitis; thus prophylactic measures should be always executed (e.g., pancreatic stent deployment).