Pancreatic Sphincterotomy

Pancreatic endoscopic sphincterotomy (PES) is a technically demanding procedure usually performed by experienced endoscopists who manage complex pancreatic and biliary disease. Despite strides in endoscopic biliary therapy after the introduction of biliary sphincterotomy in 1974 [1], complications associated with PES have prevented endoscopists from attempting it more frequently. Unlike biliary sphincterotomy, the indications of PES remain imprecise. Pancreatic sphincterotomies are performed on the major or minor papillae, depending on the treatment or management goal [2]. The basic principles for endoscopic sphincterotomy rely on selective deep pancreatic duct cannulation followed by division of the sphincter by use of electric current applied through the sphincterotome. Studies evaluating PES are limited retrospective studies and case descriptions as only a few centers perform these procedures. In this chapter, we will review the indications for pancreatic sphincterotomy, techniques involved, and reported complications.