Abstract
A 53-year-old woman with chronic alcoholic pancreatitis had abdominal pain due to a pancreatic stone in the main pancreatic duct of the pancreatic head. Since the pancreatic stone was not destroyed by extracorporeal shock wave lithotripsy, endoscopic treatment was carried out. Selective pancreatic cannulation was impossible due to the stricture and a bend proximal to the papilla of the pancreatic duct. Therefore, we performed pancreatic precut with a conventional papillotome without a leading tip and the pancreatic duct was successfully accessed. After extension of the pancreatic sphincterotomy, the wire basket was inserted into the pancreatic duct and advanced beyond the stone. However the stone was not trapped by the basket, therefore, the pancreatic stent was inserted. Although mild post-ERCP pancreatitis occurred, the patient recovered with conservative therapy. ERCP was performed 5 days after the precut. The pancreatic stent was withdrawn and the stone was successfully extracted with the basket. Six months after this treatment, the patient has been asymptomatic. There are very few manuscripts about techniques detailing gain of access to the pancreatic duct. Pancreatic precut may be helpful in cases with difficulty in selective pancreatic cannulation.
