Background/Aims: Endoscopic pancreatic sphincterotomy (EPST) has been the basis of all kinds of endoscopic treatments on the pancreatic ducts. Nevertheless, the clinical results are not yet fully established. The aim of this study was to evaluate the clinical applications and efficacy of EPST in chronic pancreatitis. Methods: EPST was performed in 52 patient with chronic pancreatitis of Cambridge classification III. The methods and fashions of EPST were analyzed and the EPST related complications such as pancreatitis, bleeding or other procedure related morbidity and mortality. Results: Technical success rate of EPST was 100%. Thirty-six patients (69.2%) underwent standard sphincterotome with or wihout guide wire assistance, 12 cases (23.1%) underwent precut pull type sphincterotomy followed by standard type, and 4 cases (7.7%) underwent needle knife sphincterotome followed by standard type. 34 procedures (65.4%) were primarily successful by EPST alone, and additional endoscopic cutting technique were required in 18 cases (34.6%) by EBST followed by EPST. The complication rate was 13.4%, mild pancreatitis in 11.5% and bleeding requiring transfusion in 1.9%. All complicatons were controlled by medical treatments. Conclusions: EPST is a safe and effective precedure for approach of pancreatic ductal system in chronic pancreatitis. And the two step EPST method of EBST followed by EPST might be necessary to improve the success rate of EPST in chronic pancreatitis.
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