Efficacy and safety of ERCP in patients with symptomatic pancreas divisum

Aims Pancreas divisum is the most frequent congenital anomaly of the pancreas. It arises from failed fusion of the dorsal and ventral pancreatic ducts. In symptomatic patients, the endoscopic intervention is proposed as first-line treatment via retrograde cholangiopancreatography(ERCP). In case of failure, surgery remains a feasible option. The aim of this research was to evaluate the efficacy and safety of ERCP in the treatment of patients with symptomatic pancreas divisum.

Methods We conducted a retrospective and descriptive study including ERCP procedures performed between January 2014 and February 2024. We collected clinical and radiological data regarding patients in whom the diagnosis of symptomatic pancreas divisum was confirmed. The success of ERCP was defined by the ability to perform minor papilla sphincterotomy with or without dorsal duct stent insertion. The adverse events of ERCP as well as the long term outcome of each patient were collected during the follow up.

Results During the study period, 22 procedures were carried out in patients with the anomaly. The median age was 44.5 years [14 years–72 years] with a male-to-female ratio of 0.83. The diagnosis was made during the exploration of recurrent acute pancreatitis in 10 patients, a first episode of acute pancreatitis in 8 patients, recurrent abdominal pains in 3 patients and chronic pancreatitis in one patient. The most observed variant of the anomaly was complete pancreas divisum in 15 patients followed by the incomplete variant that was observed in 3 patients. 2 cases with an isolated dorsal duct and 1 case associating an ansa pancreatica were identified. Endoscopic treatment was successful in 15 patients with a success rate of 77.3%. The main therapeutic option was sphincterotomy of the minor papilla alone in 13 patients and, in addition, the placement of a stent in the dorsal pancreatic duct was performed in the other 2 patients. Intervention failure was mainly associated with the inability to catheterize the minor papilla in 5 patients. Failure to visualize the minor papilla and stenosis of the duodenal bulb were the other causes of unsuccessful treatment. No subsequent complications post-ERCP were reported. During the follow up, no endoscopic reintervention due to symptoms reoccurance was necessary.

Conclusions In our study, endoscopic treatment of pancreas divisum in symptomatic patients was successful in 77.3% of the cases. Sphincterotomy alone or with stent placement were the selected therapeutic options, allowing symptom relief in all patients. Although these techniques carry numerous risks, no complications occurred during the subsequent patient follow-up.

Publication History

Article published online:
27 March 2025