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Meandering main pancreatic duct syndrome: a single-center cohort study and aggregated review
Timothy Adam1, Hannah Van Malenstein1, Wim Laleman1,2
1Department of Gastroenterology and Hepatology, Section of Liver & Biliopancreatic Disorders and Liver Transplantation, University Hospitals Leuven, KU Leuven, Belgium (Timothy Adam, Hannah Van Malenstein, Wim Laleman).
Background:
Meandering main pancreatic duct (MMPD) refers to an uncommon ductal variant of the normal smooth curvilinear course of the pancreatic duct. More specifically, MMPD is characterized by a hairpin (reverse Z-type) or loop (loop-type) turn in the pancreatic head. It has been suggested as a predisposing factor for the development of pancreatitis. Studies regarding treatment are scarce.
Methods:
We conducted a narrative review of the current literature regarding MMPD. Additionally, we present a cohort of 9 symptomatic patients treated endoscopically at our tertiary center.
Results:
Seven retrospective cohort studies and 4 case reports were included in our review. Only 1 study focuses on the clinical significance of MMPD and describes a positive association between MMPD and the onset of pancreatitis, especially recurrent acute pancreatitis. Only 1 case reports an endoscopic treatment. In our cohort of 9 MMPD patients, 7 did indeed present with recurrent acute pancreatitis. Endotherapy provided substantial regression of symptoms in 6 patients, all of whom had signs of ductal hypertension.
Conclusions:
Our review shows the scarcity of data regarding MMPD, especially concerning treatment, in the current literature. With our cohort, we not only hope to raise awareness of this often-neglected entity of recurrent acute pancreatitis, but also support the case for endotherapy for the first time in 9 symptomatic MMPD patients, especially in the presence of ductal hypertension.
Insights
Meandering main pancreatic duct (MMPD) is a rare ductal variant linked to pancreatitis. Endoscopic therapy showed symptom improvement in 9 patients with MMPD, particularly those with ductal hypertension.
Area of Science:
- Gastroenterology
- Pancreatology
- Endoscopic retrograde cholangiopancreatography (ERCP)
Background:
- Meandering main pancreatic duct (MMPD) is an uncommon anatomical variant characterized by hairpin or loop turns in the pancreatic head.
- MMPD is suspected to be a predisposing factor for pancreatitis, yet treatment data is scarce.
Purpose of the Study:
- To review the current literature on MMPD and its association with pancreatitis.
- To present a cohort of symptomatic MMPD patients treated with endoscopic therapy.
Main Methods:
- A narrative literature review was conducted.
- A cohort of 9 symptomatic MMPD patients undergoing endoscopic treatment was analyzed.
Main Results:
- Literature review revealed limited data on MMPD, especially regarding treatment.
- Seven retrospective cohort studies and 4 case reports were included.
- In the cohort, 7 of 9 MMPD patients had recurrent acute pancreatitis; 6 showed symptom improvement with endotherapy, particularly those with ductal hypertension.
Conclusions:
- There is a scarcity of data on Meandering Main Pancreatic Duct (MMPD) and its treatment in current literature.
- This study highlights MMPD as a potential cause of recurrent acute pancreatitis.
- Endotherapy is suggested as an effective treatment for symptomatic MMPD patients, especially with ductal hypertension.
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