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Endotherapy for Pancreas Divisum.

Sumant Inamdar¹, Gregory A Cote², Dhiraj Yadav³

¹Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, Shorey Building, 8th Floor, 4301 West Markham Street, Little Rock, AR 72205, USA.

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Summary

Pancreas divisum (PD), a common duct variant, has a debated link to pancreatitis. Minor papilla sphincterotomy (miES) is used for idiopathic acute recurrent pancreatitis (iRAP) with PD, with ongoing trials assessing its efficacy.

Keywords:

Minor papilla intervention Minor sphincterotomy Pancreatic divisum

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Area of Science:

Gastroenterology
Surgical Endoscopy
Pancreatic Diseases

Background:

Pancreas divisum (PD) is a frequent anatomical variation of the pancreatic duct.
The etiological link between PD and pancreatitis remains a subject of extensive debate.
Minor papilla sphincterotomy (miES) is a clinical intervention for patients diagnosed with idiopathic acute recurrent pancreatitis (iRAP) and PD.

Purpose of the Study:

To evaluate the efficacy of minor papilla sphincterotomy (miES) in patients with idiopathic acute recurrent pancreatitis (iRAP) and pancreas divisum (PD).
To address the limitations of existing observational data through a rigorous, sham-controlled trial.

Main Methods:

An international, multicenter, sham-controlled trial is currently underway.
The trial investigates the therapeutic benefits of miES in the context of iRAP and PD.

Main Results:

Current evidence primarily stems from observational studies with inherent limitations.
Data regarding the efficacy of endoscopic therapy for pain relief in chronic conditions associated with PD is limited.

Conclusions:

Endoscopic therapy, including miES, shows limited to no benefit for pain management in patients with chronic abdominal pain or chronic pancreatitis secondary to PD.
Further research, including the ongoing trial, is necessary to definitively establish the role of miES in managing iRAP associated with PD.