Pancreatic sphincterotomy: Technique, indications, and complications

Table 1 Indications for endoscopic pancreatic sphincterotomy (EPS)

EPS as primary therapy

Sphincter of Oddi dysfunction (SOD)

-Pancreatic SOD

-Biliary SOD unresponsive to biliary sphincterotomy

Chronic pancreatitis with papillary stenosis/stricture

Pancreas divisum (EPS of the minor papilla)

EPS to facilitate a further intervention

Chronic pancreatitis treated with pancreatic stent and/or stone removal

Pancreatic pseudocyst treated with transpapillary drainage

Resection of an ampullary adenoma

Pancreatic fistula treated with stent placement

Pancreatic disease due to malignancy

-Primary pancreatic cancer causing strictures, stones, pseudocysts

-Metastatic disease to the pancreas causing strictures, stones,

Table 2 Complications of endoscopic pancreatic sphincterotomy (EPS)

Early Complications (< 3 mo, typically < 72 h)

Pancreatitis

Severe bleeding

Perforation

Pancreatic and/or biliary sepsis

Late Complications (> 3 mo)

Papillary stenosis

Proximal pancreatic duct strictures

Stent-related Complications (variable timing)

Ductal and parenchymal changes

Stone formation

Infection

Ductal perforation

Stent migration

Stent occlusion

Duodenal erosion