Outcomes of Minor versus Major Papilla Rendez-vous for EUS-guided Pancreatic Duct Drainage

Aims EUS-guided pancreatic duct drainage (EUS-PD) using rendez-vous has been suggested as a safer alternative to pancreatogastrostomy. Large stones or extensive fibrosis in the pancreatic head may however preclude a major papilla rendez-vous, leading to preferential guidewire advancement through the minor papilla. Our aim was to compare the outcomes of minor and major papilla rendez-vous.

Methods This is a tertiary single-center retrospective analysis of all consecutive EUS-PD procedures performed for symptomatic chronic pancreatitis from 2015 to April 2022. Successful EUS-PD rendez-vous cases were included and minor and major papilla procedures were compared.

Results Sixty procedures were identified, of which 33 patients were included in the final analysis (66.6% male, mean age 56.1 [SD±14.8] years, 54.6% active smokers). EUS-PD was performed following failed retrograde intervention in all patients. In 21 out of 33 patients (63.6%), minor papilla rendez-vous was used. Clinical success, defined as resolution of pain/symptoms, was achieved in 81.0% vs. 58.3% in the major papilla group (p=0.230). The overall incidence of AE was similar in both groups (9 [42.9%] vs. 4 [33.3%] events, p=0.719), with a comparable distribution in severe (p=0.364), moderate (p=0.538) and mild AE (p=0.107). The recurrent pancreatitis rate was similar (28.6% vs. 25.0%, p=1.000).

Conclusions For patients with symptomatic chronic pancreatitis, EUS-PD using minor papilla rendez-vous attained similar results when compared to major papilla rendez-vous. These data suggest that in cases where a standard rendez-vous is not possible, pancreatic duct drainage through the minor papilla can be considered as equally effective.

Publication History

Article published online:
14 April 2023