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Balloon Dilatation of the Minor Duodenal Papilla Up to 4 mm is Safe in a Porcine Model

Müller, Philip C. MD*; Steinemann, Daniel C. MD*; Sauer, Peter MD; Z’graggen, Kaspar MD; Linke, Georg R. MD*,§; Müller-Stich, Beat P. MD*

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: August 2017 - Volume 27 - Issue 4 - p e44–e47
doi: 10.1097/SLE.0000000000000414
Online Articles: Original Articles

Objectives: Balloon dilatation of the minor duodenal papilla is a treatment option for symptomatic pancreas divisum. The histologic effects of balloon dilatation have not yet been evaluated. The aim of this study is to investigate the tolerated extent of dilatation of the minor papilla.

Materials and Methods: A dilatation of the minor papilla was performed in freshly explanted pancreas of pigs using biliary balloon dilatators. Three organs were not dilated (control group), in each 8 organs a dilatation of 4, 6, and 8 mm, respectively, was performed. Tissue damage was assessed by microscopic evaluation. Ductal wall disruption and perforation as well as a semiquantitative inflammation score was described and compared.

Results: Ductal wall disruption was increased by dilatation of 6 (5/8; P=0.019) and 8 mm (6/8; P=0.006) compared with 4 mm (1/8). Median inflammation score was 0 (0 to 0), 1 (0 to 2), and 1 (0 to 2) for dilatation of 4, 6, and 8 mm, respectively (4 vs. 6 mm, P=0.007; 4 vs. 8 mm, P=0.026). No perforation occurred in the 4 (0/8) and 6 mm (0/8) group, 1 perforation occurred in the 8 mm group (1/8).

Conclusions: A dilatation of up to 4 mm seems to be safe. However, dilatation of the minor papilla from 4 mm onwards is increasingly associated with tissue damage. These findings should be considered in endoscopic procedures dilating the minor duodenal papilla.

Departments of *General, Visceral and Transplant Surgery

Gastroenterology, University Hospital of Heidelberg, Heidelberg, Germany

Centre of Visceral Surgery, Klinik Beau-Site, Hirslanden, Bern

§Department of Surgery, Spital STS AG Thun, Thun, Switzerland

Presented at the 12th World Congress of the International Hepato-Pancreato-Biliary Association in Sao Paulo, April 20 to 23, 2016.

P.C.M. acknowledges a research fellowship through the Swiss Pancreas Foundation. The remaining authors declare no conflicts of interest.

Reprints: Beat P. Müller-Stich, MD, Department of General, Visceral and Transplant Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany (e-mail:

Received September 3, 2016

Accepted April 2, 2017

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