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Endoscopic approach to pancreas divisum
R A Kozarek1, T J Ball, D J Patterson
1Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Digestive Diseases and Sciences
|September 1, 1995
Summary
Endoscopic therapy for pancreas divisum can significantly reduce pancreatitis and chronic pain in select patients. However, outcomes for chronic abdominal pain syndrome are less promising, requiring further study.
Area of Science:
- Gastroenterology
- Endoscopic Therapy
- Pancreatic Disorders
Background:
- Pancreas divisum is a congenital anomaly with debated clinical significance.
- It is associated with acute relapsing pancreatitis (ARP), chronic pancreatitis (CP), and chronic abdominal pain (CAP) syndrome.
- Endoscopic and surgical treatments for accessory papilla decompression yield variable results.
Purpose of the Study:
- To evaluate the efficacy and safety of dorsal pancreatic duct decompression using endotherapy for symptomatic pancreas divisum.
- To assess patient-reported outcomes including pain, hospitalization, and global improvement.
Main Methods:
- Retrospective review of a five-year experience with endoscopic dorsal pancreatic duct decompression.
- Data collection included procedural complications, pain assessment (analog scale), hospitalization frequency, and global improvement.
- Patients were categorized into ARP, CP, and CAP groups.
Main Results:
- Significant decrease in pancreatitis incidence for ARP (P=0.016) and CP (P=0.025) patients at 20-month follow-up.
- Significant improvement in chronic pain frequency and intensity for CP patients (P<0.001).
- Limited global improvement (1/5) and no pain improvement (P=0.262) in CAP patients with normal diagnostic tests.
Conclusions:
- Endotherapy for pancreas divisum is effective in a subset of carefully selected patients, particularly those with ARP and CP.
- Chronic abdominal pain syndrome patients showed minimal response to endotherapy.
- Mild complications (20%) and restenosis (11.5%) were observed; long-term follow-up is necessary to define the role of endotherapy.
