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Pancreas Divisum.

Asif Khalid¹, Adam Slivka

¹Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA. khalid2@pitt.edu

Current Treatment Options in Gastroenterology

|September 19, 2001

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Endoscopic therapy for pancreas divisum is effective for acute recurrent pancreatitis (80%) and chronic pancreatitis (50%). Minor papilla sphincterotomy is preferred over stenting due to fewer complications and better outcomes.

Area of Science:

Gastroenterology
Endoscopic Surgery
Pancreatic Diseases

Background:

Pancreas divisum is a congenital anomaly where the pancreatic ducts do not fuse properly.
It can lead to recurrent acute pancreatitis or chronic pancreatitis in some individuals.
Endoscopic therapy is a treatment option for symptomatic pancreas divisum.

Purpose of the Study:

To evaluate the efficacy and outcomes of endoscopic therapy for pancreas divisum.
To compare minor papilla sphincterotomy with chronic stent therapy.
To determine the success rates in patients with acute recurrent pancreatitis and chronic pancreatitis.

Main Methods:

Endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla cannulation using specialized catheters and wires.

Related Experiment Videos

Minor papilla sphincterotomy performed with a papillotome and blended current.

Temporary pancreatic duct stenting post-procedure to prevent pancreatitis.

Surgical sphincteroplasty offered for cases where endoscopic therapy fails or is not feasible.

Main Results:

Response rates of 80% for acute recurrent pancreatitis and 50% for chronic pancreatitis.
Minor papilla sphincterotomy shows advantages over chronic stenting, avoiding repeated procedures and stent-induced duct changes.
Successful outcomes are more likely when performed with primary intent to treat diagnosed pancreas divisum.

Conclusions:

Endoscopic therapy, particularly minor papilla sphincterotomy, is an effective treatment for symptomatic pancreas divisum.
This approach yields good response rates in patients with pancreatitis.
Surgical intervention remains an option for refractory cases or when endoscopic therapy is not possible.