Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates - 16/08/11

Doi : 10.1016/j.gie.2006.02.057

Augustin Attwell, MD ^⁎, Gregory Borak, MD, Robert Hawes, MD, Peter Cotton, MD, Joseph Romagnuolo, MD
Current affiliations: Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (A.A.); Division of Gastroenterology, Department of Medicine, Digestive Diseases Center, Medical University of South Carolina, Charleston, South Carolina (R.H., P.C., J.R.); Gastroenterology Consultants of Savannah, Savannah, Georgia (G.B.)

Reprint requests: Augustin Attwell, MD, Department of Medicine, Division of Gastroenterology, Vanderbilt University Medical Center, 1501 The Vanderbilt Clinic, Nashville, TN 37232.

Charleston, South Carolina, USA

Abstract

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 restensosis (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.

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