Endoscopic approach via the minor duodenal papilla.

BACKGROUND/AIMS We describe procedures for endoscopic approach via the minor papilla in symptomatic patients with pancreas divisum, pancreatic stones, and stricture of the Santorini's duct, and neoplasms of the minor papilla: endoscopic minor papilla sphincterotomy, endoscopic pancreatic stone removal, endoscopic stent placement in Santorini's duct, and resection of minor papilla neoplasms. METHODS The most important procedural detail was insertion of a guide wire into Santorini's duct via the minor papilla, requiring gentle manipulation of both the cannula and guide wire to avoid subsequent complications such as pancreatitis. RESULTS Minor papilla sphincterotomy was most effective in the treatment of patients with pancreas divisum and associated with acute recurrent pancreatitis; these patients are the best candidates for endoscopic dorsal duct decompression including minor papilla sphincterotomy and stenting. Endoscopic treatment via the minor duodenal papilla was the only useful method for patients whose lesions could not be approached via the major papilla. It is a safe procedure to relieve pain. Long-term results of dorsal ductal stenting were satisfactory in 76 and 90% of patients (19/25 and 9/10, respectively). CONCLUSION The high level of endoscopic skills necessary and the small number of patients who need these procedures should limit this approach to select institutions with appropriate endoscopic expertise.