针状刀纵行预切开副乳头在ERCP治疗胰腺分裂症中的应用OA

Objective To explore the application efficacy and to summarize the experience of needle-knife longitudinal pre-cutting of the minor papilla for successful cannulation,when both conventional guidewire-guided technique and the rendezvous technique fail to access the minor pancreatic duct via the minor papilla in patients with pancreas divisum who underwent endoscopic retrograde cholangiopancreatography(ERCP).Methods A retrospective analysis was performed on the data of 35 pancreas divisum patients admitted to General Hospital of Western Theater Command of Chinese People's Liberation Army between January 2022 and July 2025.Among them,8 patients conventional cannulation techniques failed to achieve minor pancreatic duct cannulation via the minor papilla and achieved successful cannulation after longitudinal needle-knife pre-cutting.The surgical procedure was as follows:the needle-knife length was trimmed to 2 to 3 mm;with a 50 W mixed electrocoagulation mode(predominantly cutting current),the sphincter was incised layer by layer from inferior to superior along the longitudinal bulge of the minor papilla,in the direction from the 12 o'clock to 10 o'clock position at the minor papilla orifice.Once clear pancreatic juice outflow or grayish-white ductal structure was visualized,the guide wire was tentatively advanced into the minor pancreatic duct in a timely manner.Results The operation time of all the 8 patients was 78 to 148 minutes,with an average of(121.4±26.4)minutes.The postoperative hospitalization time was 3 to 5 days,with an average of(3.8±0.9)days.All eight patients experienced significant relief of abdominal pain at 24 hours postoperatively,with no severe complications such as bleeding or perforation.The short-term abdominal pain remission rate was 100%.During follow-up,six patients had no recurrence of abdominal pain within one year and underwent stent removal;1 patient developed symptom recurrence due to stent dislodgement and was relieved after repeated ERCP;1 patient had hyperlipidemic pancreatitis and showed no recurrence after lipid-lowering treatment.Conclusion Longitudinal pre-cutting with a needle-knife is safe and yields a high cannulation success rate,serving as a reliable pretreatment method to improve the success rate of ERCP for pancreas divisum.