Document Detail


Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates.
MedLine Citation:
PMID:  17055861     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. PATIENTS AND 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. INTERVENTIONS: 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.
Authors:
Augustin Attwell; Gregory Borak; Robert Hawes; Peter Cotton; Joseph Romagnuolo
Publication Detail:
Type:  Journal Article     Date:  2006-09-01
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  64     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-23     Completed Date:  2007-02-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  705-11     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Gastroenterology, Vanderbilt University Medical Center, 1501 The Vanderbilt Clinic, Nashville, TN 37232, USA.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / etiology,  surgery
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cholangiopancreatography, Endoscopic Retrograde
Equipment Safety
Female
Follow-Up Studies
Humans
Male
Middle Aged
Needles*
Pancreas / abnormalities*,  surgery*
Pancreatitis / etiology,  surgery
Postoperative Complications / etiology,  surgery
Predictive Value of Tests
Proportional Hazards Models
Recurrence
Reoperation
Retrospective Studies
Sphincterotomy, Endoscopic / instrumentation*,  methods*
Stents
Treatment Outcome
Comments/Corrections
Comment In:
Gastrointest Endosc. 2006 Nov;64(5):712-5   [PMID:  17055862 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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