Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates

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 restensosis (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.