Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates

Gastrointest Endosc. 2006 Nov;64(5):705-11. doi: 10.1016/j.gie.2006.02.057. Epub 2006 Sep 1.


Background: Technical options for pancreatic sphincterotomy of the minor papilla for pancreas divisum include a needle-knife cut over a plastic stent and a standard pull-type cut with a sphincterotome.

Objective: Our objective was to compare the frequency, safety, and intermediate-term efficacy of these 2 techniques at our institution.

Patients and methods: Retrospective review of the GI-Trac database from July 1994 to July 2004 for patients with pancreas divisum undergoing an initial minor papilla sphincterotomy.

Interventions: Patients were separated into 2 groups on the basis of the endoscopic pancreatic sphincterotomy technique used, either a needle-knife sphincterotomy (NKS) or standard pull-type sphincterotomy (PTS). The groups were compared on the basis of need for any reintervention, restenosis rates, and complication rates with use of Cox proportional hazards models.

Results: There were 133 patients (72%) in the NKS group and 51 (28%) in the PTS group. Clinical presentations were similar in the 2 groups. At a median follow-up of 5 years, additional endoscopic therapy including repeat endoscopic pancreatic sphincterotomy, endoscopic balloon dilation, stone extraction, or stenting was necessary in 29% of patients after NKS and in 26% after PTS. Papillary restenosis rates were 24% over a median follow-up of 6 years after NKS and 20% over a median follow-up of 5 years after PTS. Overall complication rates were similar in those undergoing NKS and PTS (8.3% vs 7.8%). Age less than 40 years independently predicted reintervention (hazard ratio 2.21) and restenosis (hazard ratio 2.41) (both P < .01).

Conclusions: NKS is used more than PTS for minor papilla sphincterotomy at our institution, but the 2 techniques appear equally safe and effective. Younger age may be associated with higher reintervention rates.

MeSH terms

  • Abdominal Pain / etiology
  • Abdominal Pain / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cholangiopancreatography, Endoscopic Retrograde
  • Equipment Safety
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Needles*
  • Pancreas / abnormalities*
  • Pancreas / surgery*
  • Pancreatitis / etiology
  • Pancreatitis / surgery
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Sphincterotomy, Endoscopic / instrumentation*
  • Sphincterotomy, Endoscopic / methods*
  • Stents
  • Treatment Outcome