Endoscopic minor papilla sphincterotomy

Adaptations of endoscopic treatment of the minor papilla are performed in patients with main pancreatic duct stricture in the head of the pancreas in those with chronic pancreatitis, chronic pancreatitis patients who are difficult to treat because of extensive flexure in the head of the pancreas, patients with a pancreatic stone in the accessory pancreatic duct region, and patients with pancreatic divisum. In such patients, we perform endoscopic minor papilla sphincterotomy (EMPST) to cut the minor papilla up to the superior border in the direction of 12 to 1 o'clock. Bleeding, acute pancreatitis, and perforation are reported as complications of EMPST. In endoscopic pancreatic stone removal via the minor papilla, we insert a basket catheter along with a guidewire, and open the basket catheter while being careful not to injure the pancreatic duct wall, and remove stones that had been fragmented to a size of 5~6mm by extracorporeal shockwave lithotripsy. Acute pancreatitis, basket impaction, and pancreatic juice outflow disorders with minor papilla edema are reported as complications of endoscopic pancreatic stone removal via the minor papilla. We perform endoscopic stent placement via the minor papilla to insert a stent of 5 Fr along with a guidewire in patients who do not undergo EMPST, or a stent of 5∼7 Fr along with a guidewire in patients in whom we perform EMPST. Stent obstruction, migration, and transformation of the pancreatic duct are reported as complications of endoscopic stent placement via the minor papilla. We review the procedures of these endoscopic treatments by describing cases that we have treated.