The Prevalence of Pancreas Divisum and Its Association with Pancreatic Diseases: A Systematic Review and...

Background and Objectives: Pancreas divisum (PD) is the most common congenital anomaly of the pancreatic ductal system and has been suggested to contribute to pancreatic pathology. However, its true prevalence and relationship with pancreatic diseases remain debated. This systematic review and meta-analysis aimed to estimate the global prevalence of PD and evaluate its association with pancreatic disease. Materials and Methods: A comprehensive search of Google Scholar, Scopus, and PubMed was conducted to identify studies reporting the prevalence of PD across all populations and diagnostic modalities. Pooled prevalence estimates were calculated using a random-effects model. Between-study heterogeneity was assessed using the I² statistic, and publication bias was evaluated using Egger's test. Results: A total of 117 studies comprising 193,672 subjects were included. The pooled global prevalence of PD was 11.1% (95% CI: 8.0-14.2%) with substantial heterogeneity (I² = 99.96%). PD prevalence was higher among individuals with pancreatic disease (18.7%) compared with cadaveric/autopsy studies (8.8%), healthy individuals (5.6%), and consecutive patients (4.7%). Both complete and incomplete PD were more common in subjects with pancreatic diseases. Among PD subtypes, type I was the most prevalent. Egger's test demonstrated significant publication bias (p < 0.01). Conclusions: PD affects approximately one in ten individuals worldwide and appears more prevalent in patients with pancreatic diseases. However, this finding should be interpreted with caution due to potential selection bias from predominantly ERCP-based studies.