Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum.
OBJECTIVE
A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla.


METHODS
Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a pancreatic stent or a nasal pancreatic drainage catheter was placed for 1 week. If a stricture or obstruction was evident, it was treated with balloon dilation followed by long-term stent placement (1 year). When an outflow of pancreatic juice was disturbed by a pancreatic stone, endoscopic stone extraction was performed.


RESULTS
Balloon dilation and stent placement were achieved and were successful in all the cases (16/16; 100%). Clinical improvement was achieved in 7 (84.7%) of the 9 patients with recurrent acute pancreatitis and in 6 (85.7%) of the 7 patients with chronic pancreatitis. Early complications were observed in 1 (6.3%) patient. Pancreatitis or bleeding related to balloon dilation was not observed.


CONCLUSIONS
Endoscopic balloon dilation for the minor papilla is feasible for the management of symptomatic pancreas divisum.
From the *Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo; and †Department of Endoscopy and Endoscopic Surgery, Tokyo University Hospital, Tokyo, Japan.
Natsuyo
N
Yamamoto
Hiroyuki
H
Isayama
Naoki
N
Sasahira
Takeshi
T
Tsujino
Yousuke
Y
Nakai
Koji
K
Miyabayashi
Suguru
S
Mizuno
Hirofumi
H
Kogure
Takashi
T
Sasaki
Kenji
K
Hirano
Minoru
M
Tada
Kazuhiko
K
Koike
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome