ORIGINAL ARTICLE DOI: 10.3904/kjim.2009.24.3.190 Endoscopic Pancreatic Sphincterotomy: Indications and Complications Yong Won Joo, Jai Hoon Yoon, Seung Chul Cho, Kang Nyeong Lee, Na Rae Ha, Hang Lak Lee, Oh Young Lee, Byung Chul Yoon, Ho Soon Choi, Joon Soo Hahm, Dong Hoo Lee, and Min Ho Lee Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea Background/Aims: Although a few recent studies have reported the effectiveness of endoscopic pancreatic sphincterotomy (EPST), none has compared physicians’ skills and complications resulting from the procedure. Thus, we examined the indications, complications, and safety of EPST performed by a single physician at a single center. Methods: Among 2,313 patients who underwent endoscopic retrograde cholangiopancreatography between January 1996 and March 2008, 46 patients who underwent EPST were included in this retrospective study. We examined the indications, complications, safety, and effectiveness of EPST, as well as the need for a pancreatic drainage procedure and the concomitant application of EPST and endoscopic sphincterotomy (EST). Results: Diagnostic indications for EPST were chronic pancreatitis (26 cases), pancreatic divisum (4 cases), and pancreatic cancer (8 cases). Therapeutic indications for EPST were removal of a pancreaticolith (10 cases), stent insertion for pancreatic duct stenosis (9 cases), nasopancreatic drainage (7 cases), and treatment of sphincter of Oddi dysfunction (1 case). The success rate of EPST was 95.7% (44/46). Acute complications of EPST included five cases (10.9%) of pancreatitis and one of cholangitis (2.2%). EPST with EST did not reduce biliary complications. Endoscopic pancreatic drainage procedures following EPST did not reduce pancreatic complications. Conclusions: EPST showed a low incidence of complications and a high rate of treatment success; thus, EPST is a relatively safe procedure that can be used to treat pancreatic diseases. Pancreatic drainage procedures and additional EST following EPST did not reduce the incidence of procedure-related complications. (Korean J Intern Med 2009;24:190-195) Keywords: Sphincterotomy, endoscopic; Pancreatic ducts; Complications; Safety INTRODUCTION Anatomically, the sphincter of Oddi is divided primarily into the bile duct sphincter located in the distal common bile duct, the pancreatic duct sphincter forming the distal pancreatic duct, and the ampullary sphincter, which is present in the common bile duct and the common pan- creatic duct. In endoscopic sphincterotomy (EST), only the ampullary sphincter and bile duct sphincter are resected, while the pancreatic sphincter is left intact [1]. In the clinical setting, EST was first used in 1974 by Kawai in Received: July 17, 2008 Accepted: September 25, 2008 Japan and Classen in Germany. Since then, its safety and effectiveness have been demonstrated and it is acknowl- edged as an important procedure in the diagnosis and treatment of biliary disease [2]. Endoscopic pancreatic sphincterotomy (EPST) was first described by Fuji et al. in 1976. Because of its technical difficulty and complications, however, its use has been restricted in the clinical field [3]. Because of this, the methods, indications, and safety of EPST have not been established. Various proposals have been made as to whether EST or EPST should be performed first [4-8]. Correspondence to Ho Soon Choi, M.D. Department of Internal Medicine, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea Tel: 82-2-2290-8379, Fax: 82-2-2298-9183, E-mail: choihs@hanyang.ac.kr