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Treatment of Difficult Minor Papilla Cannulation in Patients of Pancreatic Divisum

Using Endoscopic Ultrasonography–guided Puncture Combined With Endoscopic Retrograde Cholangiopancreatography

2 Cases and Literature Review

Huang, Pingxiao MD; Di, Shujie MMed; Fan, Yan MMed; Wang, Jian MMed; Zhang, Heng MD; Wu, Jie MMed

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p e60–e64
doi: 10.1097/SLE.0000000000000686
Online Articles: Technical Reports
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Context: Pancreas divisum (PD), the most common congenital anatomic variation of the pancreatic ductal system, is still rare in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for patients with symptomatic PD. However, even by experienced endoscopists, the procedure of ERCP can fail in 3% to 10% of cases. Traditionally, if we fail in cannulation we have no choice but to rely on surgery.

Case ReportThe 2 case reports of PD in this study with cannulation were both unsuccessful, fortunately, the use of endoscopic ultrasonography–guided pancreatic duct puncture combined with ERCP was eventually successful in treatment.

Conclusions: Using endoscopic ultrasonography–guided pancreatic duct puncture combined with ERCP is safe and effective for the treatment of the patients of difficult minor papilla cannulation in patients of PD, and can be used as a remedy for minor papilla cannulation failure.

Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

S.D. is co-first author.

The author declares no conflicts of interest.

Reprints: Yan Fan, MMed, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China (e-mail: gracelier@126.com).

Received January 11, 2019

Accepted April 22, 2019

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