Endoscopic interventions via the minor papilla

Introduction: Endoscopic interventions are demanding on the minor papilla. The main indications are pancreas divisum with acute relapsing or chronic pancreatitis. Recently, it has been used as alternative approach to the pancreatic duct, in case of impossible cannulation of the maior papilla.

Patients and methods: During the last 5 years we have performed endoscopic manipulations on the minor papilla in 15 patients. We had 13 men and 2 women; the median age was 56 (30–62) years. Previous pancreatic surgery was performed in 6 pts, while previous endotherapy was applied in 3 pts. The main indications for ERCP were: pain in 14, severe weight loss in 4, jaundice in 3 and pancreatic ascites in one patient. Seven patients had pancreas divisum, others suffered from severe chronic calcifying pancreatitis that occluded the Wirsung duct. We performed endoscopic pancreas sphincterotomy mainly with needle knife on the minor papilla in 12 pts, in 3 pts cannulation of the minor papilla remained unsuccessful even after precutting in 2 cases. We observed mild or moderate complications in 4 pts. Patients needed 4 (1–12) ERCPs on average.

Results: We removed pancreatic duct stones from 5 pts, we placed nasopancreatic catheter for lavage with citrate via minor papilla in 8 pts. Finally we placed 7–10 French teflon stents into the dorsal duct in 9 pts. The median duration of the drainage was 2.5 months. Fourteen pts was followed for on average of 27 (1–60) months. Eleven patients (78.6%) are doing well without symptom recurrence, 1 patient needed a further endoscopic treatment, and two patients had to be operated on, one of them died.

Conclusion: Endotherapy performed via the minor papilla can be successful in patients with chronic pancreatitis as in pancreas divisum. A satisfactory long term results can be achieved using various endoscopic therapeutic modalities.