Endoscopic Pancreatic Sphincterotomy: Dual Sphincterotomy vs. Endoscopic Pancreatic Sphincterotomy Alone

We read with interest the article by Jakobs et al. concerning endoscopic pancreatic sphincterotomy (EPS) in patients with chronic pancreatitis [1]. They concluded that EPS in patients with chronic pancreatitis is a fairly safe procedure, with a high rate of technical success. We agree that EPS is a safe procedure for chronic pancreatitis. However, we have some questions on EPS technique.

Firstly, the EPS technique used is not described in detail in this article. Was EPS routinely performed with dual sphincterotomy, or EPS alone? It has been generally accepted that biliary sphincterotomy is mandatory to avoid possible cholangitis due to edema after pancreatic sphincterotomy [2]. However, in a previous report, we suggested that dual sphincterotomy may be indicated only in selected patients who have both a dilated bile duct and elevated serum alkaline phosphatase in chronic pancreatitis. Routine biliary sphincterotomy may not be absolutely necessary for pancreatic sphincterotomy [3].

Secondly, the article provides no information on the occurrence of cholangitis after EPS alone; we would like to know whether or not any cases of cholangitis developed.

References

• 1 Jakobs R, Benz C, Leonhardt A. et al . Pancreatic endoscopic sphincterotomy in patients with chronic pancreatitis: a single-center experience in 171 consecutive patients.  Endoscopy. 2002;  34 551-554
• 2 Cremer M, Devière J, Delhaye M. et al . Stenting in severe chronic pancreatitis: results of medium-term follow-up in 76 patients.  Endoscopy. 1991;  23 171-176
• 3 Kim M H, Myung S J, Kim Y S. et al . Routine biliary sphincterotomy may not be indispensable for endoscopic pancreatic sphincterotomy.  Endoscopy. 1998;  30 697-701