title: Endoscopic approach through the minor papilla for the management of pancreatic diseases.
abstract: OBJECTIVE
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Nao
authors.initials: N
authors.lastname: Fujimori
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.forename: Akira
authors.initials: A
authors.lastname: Asou
authors.forename: Ken
authors.initials: K
authors.lastname: Kawabe
authors.forename: Lingaku
authors.initials: L
authors.lastname: Lee
authors.forename: Takamasa
authors.initials: T
authors.lastname: Oono
authors.forename: Taichi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Niina
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hijioka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Uchida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
keywords: Endoscopic papillotomy; Endoscopic retrograde cholangiopancreatography; Minor papilla; Pancreas divisum; Pancreatitis