Technical success, clinical efficacy, and safety of endoscopic minor papilla interventions for symptomatic pancreatic diseases

Table 1 Baseline characteristics of patients who underwent endoscopic minor papilla intervention procedures for symptomatic pancreatic diseases

Characteristics	Value
Demographics (n = 43)
Sex
Male	31 (72.1)
Female	12 (27.9)
Age (year)	48.7 ± 12.7
Abdominal pain symptom (n = 43)
Duration of abdominal pain (months)	24 (0.5-206)
Pain requiring hospitalization	30 (73.2)
Chronic recurrent pain requiring analgesic drugs	26 (61.9)
Narcotics	9 (34.6)
NSAIDs	17 (65.4)
Concurrent cholangitis/bile stasis (n = 28)
Cholangitis	10 (24.4)
Bile stasis	18 (43.9)
Indications for EMPI (n = 43)1
OCP	32 (74.4)
OCP with obstruction of MPD or pancreatic sphincter	27 (62.8)
OCP due to a downstream MPD stone or stricture	22 (51.2)2
OCP due to a pancreatic sphincter stricture	2 (4.7)
OCP due to a tumorous stricture	3 (7.0)
OCP with reverse-Z type of MPD	4 (9.3)3
OCP with dorsal duct stones	1 (2.3)4
Pancreas divisum	8 (18.6)5
IPMN	3 (7.0)
Classification of APD (n = 21)
Long-type	13 (61.9)
Short-type	8 (38.1)
Laboratory tests (n = 42)
Elevated serum amylase or lipase	6 (14.3)
Abnormal liver enzyme	12 (28.6)

¹One or more indications may exist in 1 case.

²Including 12 cases with both stones and strictures, 7 cases of impacted stones, and 8 cases with severe strictures; 3 cases were associated with a pseudocyst.

³Two cases with strictures and two cases with both stones and strictures.

⁴One case of obstructive chronic pancreatitis due to complex pancreaticobiliary maljunction with pancreas divisum accompanied by obstructing stones in the dorsal duct and common bile duct.

⁵Including 6 cases with complete pancreas divisum, 1 with pancreas divisum without the ventral duct, and 1 with incomplete pancreas divisum (type 1 with a ventral duct stricture). Clinically, 5, 1, and 2 had pancreatic-type pain, recurrent acute pancreatitis, and chronic pancreatitis, respectively.

Data are expressed as n (%), mean ± SD, or median (range), where appropriate. APD: Accessory pancreatic duct; EMPI: Endoscopic minor papilla intervention; IPMN: Intraductal papillary mucinous neoplasm; MPD: Main pancreatic duct; NSAIDs: Non-steroidal anti-inflammatory drugs; OCP: Obstructive chronic pancreatitis.

Table 2 Primary and secondary outcomes of endoscopic minor papilla intervention for symptomatic pancreatic diseases (n = 43)

Outcomes	Value
Primary outcomes
Initial technical success of DCMP (n = 43)	32 (74.4)
Overall technical success (n = 43)	38 (88.4)1
Immediate clinical success (pain improvement; n = 43)	34 (79.1)2
OCP (n = 32)	26 (81.3)
Pancreas divisum (n = 8)	5 (62.5)
IPMN (n = 3)	3 (100.0)
Secondary outcomes
Long-term clinical success (n = 22)
Cumulative clinical success (%)
1-year	74.7
3-year	55.3
7-year	41.5
Pancreatic stone therapy (n = 16)
Complete success	7 (43.8)3
Partial success	2 (12.5)3
Unsuccess	7 (43.8)
Stenting bypass	3 (18.8)
EMP alone	1 (6.3)
Failed DCMP	3 (18.8)
Early adverse events (n = 43)	6 (14.0)
Post-ERCP pancreatitis	5 (11.5)4
Self-limited pancreatic duct bleeding	1 (2.3)
Late (> 6 months) adverse events (n = 22)5	2 (9.1)
Minor papilla stricture	1 (4.6)
Main pancreatic duct stricture	1 (4.5)

¹Additional free-hand needle knife precut minor papillotomy achieved technical success.

²Of the 9 patients with no pain improvement, 4 with unsuccessful deep cannulation and 5 received minor papilla endotherapy but failed to achieve > 50% improvement in abdominal pain.

³Clearance success of pancreatic stones was observed in 9 patients, 7 with complete success, and 2 with partial success.

⁴Including 1 severe and 4 mild post-endoscopic retrograde cholangiopancreatography

pancreatitis.

⁵Of the 34 patients with immediate clinical success after endoscopic minor papilla intervention procedures, 22 were followed up for a period of 57.5 (7-266) months.

Data are expressed as n (%) unless otherwise specified. DCMP: Deep cannulation via the minor papilla; ERCP: Endoscopic retrograde cholangiopancreatography; IPMN: Intraductal papillary mucinous neoplasm; OCP: Obstructive chronic pancreatitis.