1
|
Kuraishi Y, Nakamura A, Kondo S, Yanagisawa T, Horiuchi I, Minamisawa M, Sasaki N, Iwaya Y, Nagaya T, Umemura T. Endoscopic assessment of minor papilla morphology: Predictors of successful cannulation and procedural pancreatitis risk in minor papilla endotherapy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 39252430 DOI: 10.1002/jhbp.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND We evaluated for predictors of successful cannulation and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in minor papilla endotherapy (MPE), emphasizing endoscopic minor papilla morphology. METHODS We retrospectively analyzed 232 MPEs in 65 patients, assessing minor papilla morphology based on three features: bulge as "prominent" or "subtle," mucosal appearance as "papilla-like" resembling the main papilla or "SMT-like" akin to a gastrointestinal submucosal tumor, and orifice visibility as "clear" or "unclear." Cannulation success was evaluated in 65 enrolled patients, with PEP risk assessed in all 232 MPEs. RESULTS Minor papilla morphology was categorized as prominent/subtle bulge in 42/23 patients, papilla-like/SMT-like mucosal appearance in 42/23, and clear/unclear orifice visibility in 24/41. Cannulation succeeded in 54/65 patients (83%). A papilla-like appearance and clear orifice visibility was significantly associated with cannulation success. PEP incidence was 5.2% and predominantly mild. A papilla-like appearance significantly decreased PEP incidence, while precutting technique and orifice dilation significantly increased PEP risk. CONCLUSION Evaluating minor papilla morphology may help predict cannulation success and PEP risk in MPE. A papilla-like mucosal appearance prognosticates cannulation success and reduced PEP risk, with clear orifice visibility serving as a success predictor. These findings provide practical guidance for preprocedural planning by emphasizing the importance of minor papilla morphology evaluation.
Collapse
Affiliation(s)
- Yasuhiro Kuraishi
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Akira Nakamura
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Shohei Kondo
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Takumi Yanagisawa
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Ichitaro Horiuchi
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | | | - Nobukazu Sasaki
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Yugo Iwaya
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Tadanobu Nagaya
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| | - Takeji Umemura
- Department of Gastroenterology, Shinshu University Hospital, Nagano, Japan
| |
Collapse
|
2
|
Mandai K, Shinomiya R. Antegrade balloon dilation of the minor duodenal papilla to facilitate serial pancreatic juice aspiration cytology. Endoscopy 2022; 54:E1051-E1052. [PMID: 36007906 PMCID: PMC9737429 DOI: 10.1055/a-1913-7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Koichiro Mandai
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Ryo Shinomiya
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| |
Collapse
|
3
|
Kawaguchi S, Satoh T, Terada S, Endo S, Shirane N. Diagnostic ability of pancreatic juice cytology via the minor papilla in patients with pancreas divisum. DEN OPEN 2022; 2:e62. [PMID: 35310692 PMCID: PMC8828241 DOI: 10.1002/deo2.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022]
Abstract
Background and study aim Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed via the major papilla when evaluating patients with pancreatic disease. However, in patients with pancreas divisum (PD) or distortion of the main pancreatic duct, endoscopic retrograde pancreatography (ERP) should be performed via the minor papilla (MP). Our aim was to evaluate the efficacy and safety of endoscopic pancreatic juice cytology (PJC), performed via the MP, in patients with PD. Patients and methods Patients with PD who underwent diagnostic ERP via the MP, between January 2010 and February 2021, were identified retrospectively from our hospital's ERCP database. Twenty‐two patients contributing to 24 ERCPs were included in the analysis. Results MP cannulation was successful in 23 of 24 ERCPs (96%). In one patient, successful cannulation was achieved on the second attempt and the procedure was performed twice in another. Serial pancreatic juice aspiration cytologic examination (SPACE) was performed in 17 patients, with a single aspiration of pancreatic juice performed in the other five. The sensitivity, specificity, and accuracy rates of ERCP diagnosis, overall, were 56%, 100%, and 80%, respectively. When diagnosis only based on SPACE was considered, the accuracy rate was even higher at 87%. Three patients (13%) developed mild pancreatitis as an adverse event. Conclusions The diagnostic ability of endoscopic PJC, via the MP in patients with PD was technically feasible and relatively effective under experienced pancreatobiliary endoscopists, however, requiring careful attention to post‐ERCP pancreatitis when performed.
Collapse
Affiliation(s)
- Shinya Kawaguchi
- Department of Gastroenterology Shizuoka General Hospital Shizuoka Japan
| | - Tatsunori Satoh
- Department of Gastroenterology Shizuoka General Hospital Shizuoka Japan
| | - Shuzo Terada
- Department of Gastroenterology Shizuoka General Hospital Shizuoka Japan
| | - Shinya Endo
- Department of Gastroenterology Shizuoka General Hospital Shizuoka Japan
| | - Naofumi Shirane
- Department of Gastroenterology Shizuoka General Hospital Shizuoka Japan
| |
Collapse
|
4
|
Balloon Dilatation of the Minor Duodenal Papilla Up to 4 mm is Safe in a Porcine Model. Surg Laparosc Endosc Percutan Tech 2017; 27:e44-e47. [PMID: 28520650 DOI: 10.1097/sle.0000000000000414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
|
5
|
Kwon CI, Gromski MA, Sherman S, El Hajj II, Easler JJ, Watkins J, McHenry L, Lehman GA, Fogel EL. Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis. Endoscopy 2017; 49:371-377. [PMID: 28201840 PMCID: PMC5552235 DOI: 10.1055/s-0042-120996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5 %) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75 %). Among these responders, 10 patients (83.3 %) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7 %) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail.
Collapse
Affiliation(s)
- Chang-Il Kwon
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mark A. Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Ihab I. El Hajj
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Jeffrey J. Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - James Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Lee McHenry
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Glen A. Lehman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| |
Collapse
|
6
|
Brown NG, Howell DA, Brauer BC, Walker J, Wani S, Shah RJ. Minor papilla endotherapy in patients with ventral duct obstruction: identification and management. Gastrointest Endosc 2017; 85:365-370. [PMID: 27530069 DOI: 10.1016/j.gie.2016.07.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Pancreatic duct (PD) cannulation via the major papilla may be compromised by downstream obstruction of the ventral PD from a stone or stricture. In patients with a patent accessory PD, cannulation of the minor papilla permits stenting or stone removal upstream of the ventral PD obstruction. Data on this technique are limited. METHODS University of Colorado Hospital and Maine Medical Center endoscopy databases were queried for ERCPs with minor papilla cannulation. Technical success was defined as deep cannulation of the minor papilla. Minor papilla endotherapy included sphincterotomy, stricture dilation, stenting, or stone treatment. Clinical improvement was designated as >50% reduction in pain or narcotic analgesia. Follow-up was obtained by chart review and telephone contact. RESULTS Over a 22-year period, 464 patients had minor papilla cannulation. Congenital and incomplete pancreas divisum were excluded, and 64 patients met study criteria. Technical success was achieved in 58 of 64 patients (91%). In patients with stones, 25 of 34 (74%) had clearance using endoscopic techniques. Median follow-up was 15.5 months. Twelve of 28 patients (43%) on chronic narcotic regimens reported a reduction in narcotic use by >50%, and 32 of 44 patients (73%) reached for discussion noted improved abdominal pain by >50%. Thirteen patients required surgery for symptom control. CONCLUSIONS In this multicenter experience, 15% of patients undergoing minor papilla cannulation had acquired a ventral PD obstruction. Access via the minor papilla to the upstream main PD for endotherapy and clinical improvement was achieved in most patients. Increased and early recognition of these intensive therapeutic options may enhance treatment options for this complex group of patients.
Collapse
Affiliation(s)
- Nicholas G Brown
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, Colorado, USA
| | - Douglas A Howell
- Portland Gastroenterology Associates, Maine Medical Center Portland, Maine, USA
| | - Brian C Brauer
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, Colorado, USA
| | - John Walker
- Portland Gastroenterology Associates, Maine Medical Center Portland, Maine, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, Colorado, USA
| | - Raj J Shah
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, Colorado, USA
| |
Collapse
|
7
|
Wang W, Gong B, Jiang WS, Liu L, Bielike K, Xv B, Wu YL. Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla. World J Gastroenterol 2015; 21:5950-5960. [PMID: 26019460 PMCID: PMC4438030 DOI: 10.3748/wjg.v21.i19.5950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/30/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife.
METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed.
RESULTS: Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301).
CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.
Collapse
|
8
|
Brauer BC, Chen YK, Ringold DA, Shah RJ. Peroral pancreatoscopy via the minor papilla for diagnosis and therapy of pancreatic diseases. Gastrointest Endosc 2013; 78:545-9. [PMID: 23769144 DOI: 10.1016/j.gie.2013.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/07/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Brian C Brauer
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | |
Collapse
|
9
|
Fujimori N, Igarashi H, Asou A, Kawabe K, Lee L, Oono T, Nakamura T, Niina Y, Hijioka M, Uchida M, Kotoh K, Nakamura K, Ito T, Takayanagi R. Endoscopic approach through the minor papilla for the management of pancreatic diseases. World J Gastrointest Endosc 2013; 5:81-8. [PMID: 23515847 PMCID: PMC3600553 DOI: 10.4253/wjge.v5.i3.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/08/2012] [Accepted: 01/23/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To clarify the efficacy and safety of an endoscopic approach through the minor papilla for the management of pancreatic diseases.
METHODS: This study included 44 endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in 34 patients using a minor papilla approach between April 2007 and March 2012. We retrospectively evaluated the clinical profiles of the patients, the endoscopic interventions, short-term outcomes, and complications.
RESULTS: Of 44 ERCPs, 26 were diagnostic ERCP, and 18 were therapeutic ERCP. The most common cause of difficult access to the main pancreatic duct through the major papilla was pancreas divisum followed by distortion of Wirsung’s duct. The overall success rate of minor papilla cannulation was 80% (35/44), which was significantly improved by wire-guided cannulation (P = 0.04). Endoscopic minor papillotomy (EMP) was performed in 17 of 34 patients (50%) using a needle-knife (13/17) or a pull-type papillotome (4/17). EMP with pancreatic stent placement, which was the main therapeutic option for patients with chronic pancreatitis, recurrent acute pancreatitis, and pancreatic pseudocyst, resulted in short-term clinical improvement in 83% of patients. Mild post-ERCP pancreatitis occurred as an early complication in 2 cases (4.5%).
CONCLUSION: The endoscopic minor papilla approach is technically feasible, safe, and effective when the procedure is performed in a high-volume referral center by experienced endoscopists.
Collapse
Affiliation(s)
- Nao Fujimori
- Nao Fujimori, Hisato Igarashi, Akira Asou, Lingaku Lee, Takamasa Oono, Taichi Nakamura, Yusuke Niina, Masayuki Hijioka, Masahiko Uchida, Kazuhiro Kotoh, Kazuhiko Nakamura, Tetsuhide Ito, Ryoichi Takayanagi, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Nakazawa T, Hayashi K, Naitoh I, Okumura F, Joh T. Endoscopic Approach via the Minor Papilla for the Treatment of Pancreatic Stones. Clin Endosc 2012; 45:189-93. [PMID: 22977799 PMCID: PMC3429733 DOI: 10.5946/ce.2012.45.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS We aimed to evaluate whether the advanced techniques have influenced the minor papilla approach. METHODS We studied the success rate of guide wire insertion by using ordinary techniques and advanced techniques (rendezvous method and precut method) in 30 patients via the minor papilla. We compared the selection of the access routes between before (52 patients) and after (28 patients) the introduction of the Soehendra stent retriever. RESULTS In 19 out of 30 patients (63%), guide wire insertion via the minor papilla could be achieved by using ordinary techniques. In total, the guide wire could be inserted in 27 patients (90%) by using the advanced techniques. Before introduction of the Soehendra stent retriever, the major papilla approach was chosen in 38 cases (73%), and the minor papilla approach in 14 cases (27%). After introduction of the Soehendra stent retriever, the major papilla approach was used in 26 cases (93%) and the minor papilla in 2 cases (7%). The frequency of selecting the minor papilla approach has significantly decreased (p<0.05). CONCLUSIONS The advanced techniques have contributed to the improvement of endoscopic approaches via the minor papilla, and decreased the frequency of selecting the minor papilla approach.
Collapse
Affiliation(s)
- Takahiro Nakazawa
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | |
Collapse
|
11
|
Abstract
Almost all the therapeutic efforts in the treatment of chronic pancreatitis are directed towards pain control. Endoscopic techniques available for this purpose are endoscopic retrograde cholangiopancreatography (combined or not with extracorporeal shock wave lithotripsy) and endoscopic ultrasound. Pancreatic stones and strictures, pancreatic pseudocysts, and common bile duct strictures complicating chronic pancreatitis can be treated by endoscopy. The development of endoscopic ultrasound extended the possibilities in the treatment of pancreatic pseudocysts and main pancreatic duct drainage. Endoscopy is considered the first-line treatment in chronic pancreatitis and can be useful also as a 'bridge to surgery'. In fact the endoscopic approach to chronic pancreatitis can predict the response to surgical therapy as a definitive treatment. Medical, endoscopic and surgical methods for the management of chronic pancreatitis should all be considered in decision-making, and the best treatment should be chosen case by case and according to the local expertise.
Collapse
|
12
|
Gobelet J, Navarrete C, Sáenz R. [Endoscopic pancreatic sphincterotomy: when and how]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:584-91. [PMID: 17129553 DOI: 10.1157/13094352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endoscopic pancreatic sphincterotomy (EPS) has fallen into disuse for some time because of the risk of severe complications. More recently, EPS has been advocated as an effective treatment modality for several pancreatic disorders, including severe chronic pancreatitis, pancreatic pseudocyst, ampulloma, pancreas divisum, and pancreatic sphincter dysfunction. Favorable outcomes in patients undergoing EPS to facilitate further interventions, in whom long-term follow-up was available, was 70%; complications occurred in 14% and reintervention was required in 23%. The results were as good as those of surgery after long-term follow-up. Patients who underwent some form of pancreatic drainage after sphincterotomy had fewer complications (p = 0.03). Approximately 75% of patients with pancreas divisum who presented with idiopathic acute recurrent pancreatitis improved after endoscopic therapy, but only 25% of patients experienced pain reduction of at least 50%. The National Institutes of Health Consensus recommends EPS in patients with type I sphincter of Oddi dysfunction (SOD). In patients with type II SOD, prior manometry should be performed. In our series of 17 patients, we obtained results similar to those of other studies, although the number of patients was small. EPS appears to be a safe and effective technique, but further, well-designed, multicenter, prospective and long-term studies are required to evaluate these results and settle current controversies.
Collapse
|
13
|
Tarnasky PR, Linder JD. Endoscopic minor papilla interventions in patients without pancreas divisum. Gastrointest Endosc 2005; 61:349-50; author reply 350. [PMID: 15729265 DOI: 10.1016/s0016-5107(04)02595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
14
|
Affiliation(s)
- Martin L Freeman
- Division of Gastroenterology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN 55415, USA
| | | |
Collapse
|