Successful reverse cannulation and needle-knife papillotomy of the minor papilla for accessory pancreatic duct cannulation

Successful reverse cannulation and needle-knife papillotomy of the minor papilla for accessory pancreatic duct cannulation Pancreas divisum is the most common congenital malformation of the pancreas.It usually causes no symptoms or complications, but a small percentage of persons with this malformation develop recurrent acute pancreatitis.Patients with recurrent acute pancreatitis may benefit from endoscopic sphincterotomy of the minor papilla to open up the outflow of the dorsal pancreatic duct [1,2].Here, we describe a case of pancreas divisum that was treated with reverse cannulation and needle-knife papillotomy of the minor papilla and placement of a pancreatic duct stent.A 50-year-old man presented with recurrent acute pancreatitis.Pancreas divisum was diagnosed using endoscopic ultrasound and magnetic resonance cholangiopancreatography.The pancreatogram revealed that the main pancreatic duct (MPD) was bifurcated and the branched pancreatic duct was slender ( Fig. 1).