title: Wire-assisted access sphincterotomy of the minor papilla.
abstract: BACKGROUND
  Recommended techniques for minor papilla sphincterotomy include performing a standard pull-type sphincterotomy (PTS) or using a needle-knife over a stent. A wire-assisted access sphincterotomy (WAAS) technique may hold some technical advantages over these accepted methods, but has not been robustly described.
  
  
  OBJECTIVE
  To describe the safety and efficacy of WAAS compared with PTS in a series of patients from our institution.
  
  
  METHODS
  Retrospective audit of initial minor papilla sphincterotomies over a 6-year period. Demographic and procedural data were abstracted, and the medical record was reviewed for clinical follow-up.
  
  
  METHODS
  A large tertiary referral center.
  
  
  METHODS
  One hundred twenty-eight consecutive patients with pancreas divisum who underwent ERCPs between April 2001 and April 2007, 64 of whom underwent an initial minor papilla sphincterotomy.
  
  
  METHODS
  WAAS was performed by deeply cannulating the dorsal duct with a guidewire and then passing a needle-knife sphincterotome alongside the wire and cutting the minor papilla by inserting the needle-knife beside the wire and cutting away from the wire.
  
  
  METHODS
  Clinical procedural success and reported adverse events.
  
  
  RESULTS
  Thirty-two patients had recurrent acute pancreatitis, 15 had pain only, and 13 had chronic pancreatitis. Thirty-two underwent WAAS, 24 had PTS, and 8 had other types of sphincterotomies. Patients undergoing WAAS (32) versus PTS (24) were similar in age, sex, and procedural indication. Mild post-ERCP pancreatitis and mild intraprocedural bleeding occurred more commonly in the WAAS group, although the differences were not statistically significant.
  
  
  CONCLUSIONS
  Retrospective, nonrandomized study.
  
  
  CONCLUSIONS
  WAAS is an effective technique that may be used either to begin a minor papilla sphincterotomy or to perform the entire sphincterotomy. Complications appear similar to those seen with conventional methods but require a larger patient sample to fully evaluate.
authors.affiliation: Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA. john-maple@ouhsc.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Maple
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Sreenivasa
authors.initials: S
authors.lastname: Jonnalagadda
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
mesh_terms: D000208:Acute Disease; D000328:Adult; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome