Nursing management for patients with minor papilla stent placement after failed endoscopic retrograde cholangiopancreatography cannulation: Two case reports

BACKGROUNDEndoscopic retrograde cholangiopancreatography (ERCP) is the standard intervention for pancreatic ductal drainage, selective cannulation of the main pancreatic duct via the major papilla fails in 5%-10% of cases because of anatomic variants, particularly suspected pancreas divisum, and cannulation often occurs via the minor papilla. CASE SUMMARYThis case report describes two patients (a 37-year-old female and a 71-year-old female) who presented with pancreatic ductal dilation and underwent ERCP for diagnostic and therapeutic purposes.In both cases, selective cannulation of the main pancreatic duct via the major papilla failed after repeated attempts; however successful minor papilla cannulation and pancreatic stent placement were achieved without intraprocedural or postprocedural complications, including post-ERCP pancreatitis, bleeding, or perforation at the 1-month follow-up.This report emphasizes the critical role of comprehensive nursing interventions throughout the perioperative period. CONCLUSIONPreoperatively, nurses contributed to risk identification by thoroughly reviewing imaging and anatomical variations.Intraoperatively, they ensure seamless instrument preparation, timely device exchange, and steady guidewire stabilization, which are pivotal for procedural success.Postoperatively, a standardized "fasting-enzyme inhibition-fluid resuscitation" protocol was strictly implemented to enable early detection and prompt management of potential complications.These nursing strategies optimize outcomes in this high-risk population, offering a forward-looking nursing perspective for minor papillary cannulation, and proposing a nursing framework for such complex procedures.