Experience with accessory pancreatic duct (APD) endoscopic therapy in patients without pancreas divisum

H. Tang, P. R. Tarnasky, J. T. Cunningham, R. H. Hawes, P. B. Cotton

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Abstract

Endoscopic therapy to the APD has not been widely utilized apart from its role in improving pancreatic drainage with sphincterotomy or stenting in pancreas divisum. Purpose: To report experience with and propose indications for endoscopic therapy to the accessory papilla in the non-divisum setting at a single institution. Methods: The endoscopic database GI-Trac at our institution was used to identify all patients without pancreas divisum who underwent endoscopic procedures to the APD between June 1994 and June 1997. The case charts and radiology of these patients were reviewed. Results: There were 20 patients (9 male, 11 female) who fulfilled the criteria. The median age was 41 years (range 4-41 years). Endoprostheses used varied from 3F to 7F gauge depending on duct size. When sphincterotomy was performed to the accessory papilla, this was done using a needle knife over the pancreatic stent. All procedures were technically successful and no immediate complications were reported after the procedures. INDICATION THERAPY PATIENTS Chronic pancreatitis with patent/dominant APD APD stent and sphincterotomy 11 Stone in APD and main pancreatic duct (MPD) MPD and APD sphincterotomy and stent 2 Stricture/stone in distal MDP APD stent/dilatation and sphincterotomy 3 APD stricture APD stricture 2 Ansa pancreatica with stone and stricture APD stent and sphincterotomy 2 Conclusion: Endoscopic therapy to the APD is a safe and effective therapeutic option to provide drainage of the pancreatic duct in (1) patients with chronic pancreatitis a patent or dominant APD (2) patients where access to the MPD via the major papilla is not possible due to stones or strictures (3) patients with stones or strictures within the APD.

Original languageEnglish (US)
Pages (from-to)AB140
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - Dec 1 1998

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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