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


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.


METHODS
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.
Attwell
Augustin
A
Department of Medicine, Division of Gastroenterology, Vanderbilt University Medical Center, 1501 The Vanderbilt Clinic, Nashville, TN 37232, USA.
Borak
Gregory
G
Hawes
Robert
R
Cotton
Peter
P
Romagnuolo
Joseph
J
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation* / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome