Management of patients with pancreas divisum requiring endoscopic treatment – a single center experience

Aims Pancreas divisum (PD) is the most common congenital pancreatic ductal variant and can be present in approximately 10% of the population. It can be associated with pancreatobiliary-type pain and recurrent acute pancreatitis (AP), which may present as an indication for endoscopic treatment by endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy (EST) and/or pancreatic duct stenting. We aim to demonstrate our experience in the management of symptomatic patients with PD.

Methods All consecutive patients with PD who underwent ERCP during a half-year period (01. 10.2022-10.03.2023) at our tertiary care center were included. Demographic data, indications, procedural interventions, and findings, as well as available data of clinical outcome were analyzed.

Results Overall 5 patients with PD underwent ERCP during the study period. Mean age was 22.4 years (standard deviation (SD)±17.1). Three of them were referred from pediatric departments. In terms of gender 4 patients were male and 1 patient was female. Indications were recurrent AP in all patients and in addition, signs of disconnected duct syndrome were seen in two cases. PD was unknown before ERCP in one patient. Failure to cannulate the minor papilla occurred in one individual, however pancreatic EST of the major papilla was successfully performed. Cannulation of the minor papilla without precut EST was successful in one patient. Procedure related complications emerged in two cases, one case of mild post-ERCP pancreatitis and one case of self-limiting post-EST related bleeding. Four patients have been controlled at follow-up visits. Average follow-up time was 77 days (SD±31.9). During that period 2 patients were presented with self-limiting mild AP which were successfully treated conservatively. One was associated with pancreatic stent dislodgement and AP resolved quickly after stent extraction. All patients (including the two with AP relapse) have become pain-free and their general condition has improved. The first follow-up visit for the one remaining patient is already scheduled.

Conclusions Though limited by low number of patients, our study demonstrates clinically significant domestic experience in the endoscopic treatment of patients with PD during a half-year period. Our results show good technical and clinical success rates with low adverse event rates. Nevertheless, performing ERCP in patients with PD should always be based on careful individual evaluation of clinical presentation due to potentially high risk of complications.

Publication History

Article published online:
15 April 2024