ORIGINAL ARTICLE

JOP. J Pancreas (Online) 2004; 5(3):122-131.

Outcome of Endoscopic Minor Papillotomy in Patients with Symptomatic Pancreas Divisum

Henning Gerke1, Michael F Byrne1, Helen L Stiffler1, Jorge V Obando2, Robert M Mitchell1, Paul S Jowell1, Malcolm S Branch1, John Baillie1

1Department of Medicine, Division of Gastroenterology, Duke University Medical Center. Durham, North Carolina, USA. 2Lahey Clinic, Burlington, Massachusetts, USA

ABSTRACT

Context Pancreas divisum has been associated with recurrent acute pancreatitis, chronic abdominal pain without elevated pancreatic enzymes, and chronic pancreatitis. Prior studies suggest that endoscopic minor papillotomy benefits certain symptomatic pancreas divisum patients. However, the data are quite limited and there is a lack of long-term follow-up.

Objective To describe a retrospective study of endoscopic minor papillotomy for pancreas divisum.

Patients Eighty-nine adult patients who underwent endoscopic minor papillotomy at our referral center were included in the study. Median follow-up was 29 months.

Intervention We conducted a telephone survey. Fifty-three patients were available for the telephone survey.

Results Thirty-two patients (60.4%) reported immediate improvement: however, symptoms recurred in 17 (53.1% of the immediate responders). Repeat endoscopic interventions were performed in 8 patients, with long-term improvement in two. Overall long-term improvement was achieved in 17 patients (32.1%). Results of minor papillotomy were more favorable for patients with recurrent, well-defined bouts of pancreatitis (immediate improvement: P=0.036; long-term improvement: P=0.064) compared to those with pancreatitis who reported continuous pain and those without clinical evidence of pancreatitis (immediate improvement: 73.3%, 42.9% and 44.4%, respectively; long-term improvement: 43.3%, 21.4%, and 11.1%, respectively).

Conclusions The long-term benefit from endoscopic minor papillotomy using strict criteria is poorer than suggested from previous studies. However, pancreas divisum patients with well-defined bouts of pancreatitis are more likely to benefit from endoscopic minor papillotomy than those without symptom-free intervals between "attacks" and those with pain that is not associated with elevated pancreatic enzymes.

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Keywords Cholangiopancreatography, Endoscopic Retrograde; Pancreas, /abnormalities; Pancreatitis, /etiology, /prevention and control, /therapy; Recurrence, /prevention and control; Sphincterotomy, Endoscopic; Treatment Outcome/P>

Correspondence Henning Gerke: gerke003@notes.duke.edu