Efficacy of Endoscopic Minor Papilla Sphincterotomy for Symptomatic Santorinicele.

Published on Feb 1, 2017in Clinical Gastroenterology and Hepatology8.549
· DOI :10.1016/J.CGH.2016.08.004
Stefano Francesco Crinò14
Estimated H-index: 14
(University of Verona),
Laura Bernardoni10
Estimated H-index: 10
(University of Verona)
+ 6 AuthorsArmando Gabbrielli26
Estimated H-index: 26
(University of Verona)
Sources
Abstract
Background & Aims Santorinicele, a rare focal cystic dilation of the distal portion of the dorsal pancreatic duct at the minor papilla, can be a cause of recurrent acute pancreatitis (RAP). Endoscopic minor papilla sphincterotomy (EMPS) has been evaluated as a treatment in case reports but never systematically investigated. Methods We performed a retrospective analysis of the efficacy of EMPS in reducing episodes of pancreatitis. We collected data on 30 patients with santorinicele and RAP who underwent EMPS from June 2009 through April 2015 at University Hospital of Verona in Italy. The mean follow-up period was 43.8 months. Results The average number of pancreatitis episodes per year before EMPS was 1.59 vs 0.18 episodes after EMPS; the average number of pancreatitis cases that occurred during a comparable time period before EMPS was 2.63 vs 0.67 cases after EMPS ( P Conclusions EMPS is effective in reducing the incidence of pancreatitis in patients with santorinicele.
📖 Papers frequently viewed together
196 Citations
163 Citations
46 Citations
References19
Newest
#1Usama Ahmed Ali (UU: Utrecht University)H-Index: 16
#2Yama IssaH-Index: 4
Last. Marja A. BoermeesterH-Index: 69
view all 20 authors...
Background & Aims Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. Methods We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, la...
94 CitationsSource
#1Enrico Boninsegna (University of Verona)H-Index: 6
#2Riccardo Manfredi (University of Verona)H-Index: 51
Last. Roberto Pozzi Mucelli (University of Verona)H-Index: 38
view all 8 authors...
Objectives To evaluate secretin-enhanced MRCP (S-MRCP) findings of patients with pancreas divisum and Santorinicele, before and after minor papilla sphincterotomy.
15 CitationsSource
#1Rajan Kanth (Marshfield Clinic)H-Index: 8
#2N. Swetha Samji (Marshfield Clinic)H-Index: 1
Last. Praveen K. Roy (Marshfield Clinic)H-Index: 5
view all 7 authors...
Abstract Pancreas divisum (PD) is the most common congenital variant of the pancreas and has been implicated as a cause of pancreatitis; however, endoscopic treatment is controversial. Our objective was to examine patient response to endotherapy for treatment of symptomatic PD in adult patients in a systematic review of the literature. A systematic review of all case series and case–control studies with ten or more patients undergoing endotherapy for treatment of symptomatic PD indicated by acut...
33 CitationsSource
#1Wataru Gonoi (UTokyo: University of Tokyo)H-Index: 17
#2Hiroyuki Akai (UTokyo: University of Tokyo)H-Index: 20
Last. Kuni Ohtomo (UTokyo: University of Tokyo)H-Index: 25
view all 13 authors...
Background Only one case of santorinicele without pancreas divisum pathophysiology (SWOPP) was previously reported. The purpose of the study was to determine the gross prevalence of SWOPP and santorinicele with pancreas divisum (SWPD) in community and patient populations, and investigate their clinical and radiographic features.
7 CitationsSource
#1Gregory Lutzak (Virginia Mason Medical Center)H-Index: 2
#2Michael Gluck (Virginia Mason Medical Center)H-Index: 27
Last. Richard A. Kozarek (Virginia Mason Medical Center)H-Index: 88
view all 4 authors...
Background Pancreas divisum patients with focal obstruction of the minor papilla and resulting dilation of the dorsal pancreatic duct [a santorinicele (SC)] have been reported to improve with endoscopic sphincterotomy of the minor papilla (ESMP). In this study, we assess the long-term efficacy of ESMP in SC patients.
7 CitationsSource
#1Sher Ali Khan (Aga Khan University)H-Index: 6
#1Saad Akhtar Khan (Aga Khan University)H-Index: 5
Last. Rizwan AzamiH-Index: 3
view all 3 authors...
: A cystic dilatation of the terminal portion of the minor pancreatic duct (duct of Santorini) is referred to as a santorinicele. It is usually associated with pancreas divisum and has been suggested to be a cause of relative stenosis of the minor papilla, often leading to recurrent pancreatitis. While this anomaly has been reported in the paediatric population, it is more commonly found in the elderly. We present a 27-year-old woman with recurrent acute pancreatitis attributed to a santorinicel...
5 Citations
#1Ki Deok Nam (Kyung Hee University)H-Index: 2
#2Kwang Ro Joo (Kyung Hee University)H-Index: 16
Last. Rin Chang (Kyung Hee University)H-Index: 15
view all 11 authors...
A santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla. Most cases reported previously were associated with pancreas divisum and a santorinicele without pancreas divisum is known to be rare. We recently experienced a typical case of a santorinicele without pancreas divisum in a 67-yr-old woman with abdominal pain and hematochezia, subsequently proven to be the result of an ischemic colitis. The santorinicele was diagnose...
5 CitationsSource
#1Kwang Ro Joo (Kyung Hee University)H-Index: 16
#2Sung Jo Bang (UOU: University of Ulsan)H-Index: 3
Last. Neung Hwa Park (UOU: University of Ulsan)H-Index: 24
view all 5 authors...
Santorinicele, a focal cystic dilatation of the distal duct of Santorini, has been suggested as a possible cause of the relative stenosis of the accessory papilla, is associated with complete pancreas divisum, which results in acute episodes of pancreatitis or pain. This report describes a case of a santorinicele, which was initially detected by upper gastrointestinal endoscopy as a polypoid mass, in a patient with recurrent abdominal pain. The mass was subsequently proved to be a santorinicele ...
5 CitationsSource
#1Jeong-Sik Byeon (UOU: University of Ulsan)H-Index: 32
#2Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 89
Last. Young Il Min (UOU: University of Ulsan)H-Index: 32
view all 9 authors...
10 CitationsSource
Acute recurrent pancreatitis (ARP) results most commonly from alcohol abuse or gallstone disease. Initial evaluation fails to detect the cause of ARP in 10 –30% of patients, and as a result the diagnosis of “idiopathic” ARP is given. In these patients, a more extensive evaluation including specialized labs, ERCP, endoscopic ultrasound, or magnetic resonance cholangiopancreatography typically leads to a diagnosis of microlithiasis, sphincter of Oddi dysfunction, or pancreas divisum. Less commonly...
154 CitationsSource
Cited By6
Newest
Abstract Background We aimed to assess factors impacting the endoscopic minor papilla sphincterotomy (EMPS) success rate, clinical efficacy, and safety in a large cohort of patients with symptomatic pancreas divisum (PD). Methods Retrospective study including patients with PD referred to the Pancreas Institute of Verona from May 2009 to May 2020 to undergo EMPS. The whole population was analyzed to assess EMPS technical success, defined as the rate of deep cannulation of the dorsal duct. Patient...
Source
Source
#1Aditya Gutta (IU: Indiana University)H-Index: 2
#1Aditya Gutta (IU: Indiana University)
Last. Stuart Sherman (IU: Indiana University)H-Index: 95
view all 3 authors...
ABSTRACTIntroduction: Pancreas divisum is the most common congenital malformation of the pancreas with the majority asymptomatic. The etiological role, pathogenesis, clinical significance and manag...
9 CitationsSource
#1Hirotsugu Maruyama (OCU: Osaka City University)H-Index: 7
#2Toshio Watanabe (OCU: Osaka City University)H-Index: 69
Last. Yasuhiro Fujiwara (OCU: Osaka City University)H-Index: 50
view all 3 authors...
Source
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 9 authors...
BACKGROUND: The association between risk of pancreatic cancer and a dilated main pancreatic duct (MPD) in intraductal papillary mucinous neoplasm (IPMN) is debated. The aim of this study was to assess the role of MPD size in predicting pancreatic cancer in resected IPMNs and those kept under surveillance. METHODS: All patients with IPMN referred to the Pancreas Institute, University of Verona Hospital Trust, from 2006 to 2016 were included. The primary endpoint was the occurrence of malignancy d...
8 CitationsSource
#1Darin L. DufaultH-Index: 5
#2B. Joseph ElmunzerH-Index: 31
Last. Gregory A. CoteH-Index: 42
view all 5 authors...
OBJECTIVES: Pancreatic endoscopic sphincterotomy (PES) is an independent risk factor for short- and long-term adverse events (AEs) of endoscopic retrograde cholangiopancreatography. We sought to measure PES-specific AEs and trends in the use of PES. METHODS: This was a retrospective cohort of consecutive patients who underwent first-time PES between June 2008 and June 2015. Indications for PES were dichotomized: (1) structural pathology (chronic pancreatitis and local complications of acute panc...
2 CitationsSource
#2Bret T. Petersen (Mayo Clinic)H-Index: 76
Most efforts to perform pancreatography for assessment of leaks, constriction, filling defects, or irregularity due to chronic pancreatitis are pursued through the major papilla at the ampullary junction with the bile duct. Endoscopic cannulation of the minor papilla is performed (a) when symptoms or imaging studies warrant attempts to diagnose and potentially treat anatomic variations of the pancreatic ductal system and (b) when access to the ventral duct at the major papilla fails or is inadeq...
Source
#1Laura Bernardoni (University of Verona)H-Index: 10
#2Stefano Francesco Crinò (University of Verona)H-Index: 14
Last. Armando Gabbrielli (University of Verona)H-Index: 26
view all 8 authors...
Background and study aims Pancreatic intraductal papillary mucinous neoplasms (IPMN) are cystic tumors of the pancreas characterized by a malignant potential. IPMN have been associated with recurrent pancreatitis (RP). Obstruction of the main pancreatic duct by thick mucus has been postulated to be the cause of pancreatitis. In a few isolated reports, pancreatic sphincterotomy (PS) has been reported to reduce the frequency of pancreatitis. The aim of this study was to assess the efficacy of PS i...
6 CitationsSource