192 The Korean Journal of Internal Medicine Vol. 24, No. 3, September 2009 Table 2. Diagnostic indications for EPST Indications Total (n=46) Without EST (n=18) With EST (n=28) Without drain (n=27) With drain (n=19) Chronic pancreatitis Major papilla 25 13 12 12 13 Minor papilla 1 0 1 1 0 Pancreatic pseudocyst 3 1 2 0 3 Pancreatic divisum Major papilla 1 0 1 1 0 Minor papilla 3 1 2 3 1 Pancreatic cancer 8 1 7 7 1 IPMN of the pancreas 2 2 0 2 0 SOD-p type 1 0 1 1 0 AUPBD with choledocal cyst 1 0 1 1 0 Restenosis of EPST 1 0 1 0 1 EPST, endoscopic pancreatic sphincterotomy; EST, endoscopic biliary sphincterotomy; IPMN, intraductal papillary mucinous neoplasm; SOD-p type, sphincter of Oddi dysfunction (pancreatic type); AUPBD, anomalous union of the pancreaticobiliary duct. Number of patients 10 7 7 2 1 3 1 Table 3. Therapeutic indications for EPST Indications Chronic pancreatitis Removal of pancreaticoliths Stents for pancreatic duct strictures Endoscopic nasopancreatic drainage Pancreas divisum Stent for pancreatic duct stricture Endoscopic nasopancreatic drainage Transpapillary stent for pancreatic pseudocyst Sphincter of Oddi dysfunction (pancreatic type) EPST, endoscopic pancreatic sphincterotomy. was chronic pancreatitis, with or without concurrent pancreaticolith and dilatation of the pancreatic duct. Eight cases occurred in which the procedure was per- formed to biopsy the pancreatic duct and to inspect it on suspicion of pancreatic cancer. In two cases, the procedure was performed to assess intraductal papillary mucinous neoplasm (IPMN) within the pancreatic duct. In four cases, the procedure was carried out to diagnose and treat pancreatic divisum. In three cases, the procedure was conducted to diagnose and treat a pancreatic pseudocyst. In one case, the procedure was performed because of sphincter of Oddi dysfunction (SOD). In one case, the procedure was performed because of the AUPBD and a choledochal cyst, and in one case because of restenosis of the pancreatic duct. The number of patients who underwent EPST alone was 18 (38.1%), while the number of patients who underwent EPST concomitantly with EST was 28 (60.9%). The number of patients who underwent pancreatic drainage procedure following EPST was 19 (41.3%), and the number of patients who did not undergo any pancreatic drainage procedure was 27 (58.7%, Table 2). In terms of therapeutic indication, EPST was performed for pancreaticolith removal in ten cases, the insertion of a stent in a stenotic lesion in nine cases, endoscopic nasopancreatic duct drainage in seven cases, the insertion of a pancreatic stent for the treatment of pancreatic pseudocysts in three cases, and the treatment of SOD in one case (Table 3). Complications of EPST Acute complications, which occurred following EPST, included five cases (10.9%) of pancreatitis and one of cholangitis (2.2%). Severe complications found in the literature, such as bleeding, perforation, pancreatic duct rupture, and sepsis, for which the hospitalization period was prolonged, did not occur. Eight cases of hyperamy- lasemia were observed that were not clinically notable, and one case of bleeding in which hemostasis was attempted by injecting epinephrine at the site where EPST was performed. Complications developed in two cases (7.1%, 2/28) in which EPST with EST and four cases (22.2%, 4/18) in which EPST alone was performed; however, this difference was not statistically significant (p=0.19). Laboratory findings were compared before and after the procedure between the groups in which EPST with EST and EPST alone were performed. Mean total bilirubin was higher in the group in which EPST with EST