An endoscopic sphincterotomy of the minor papilla in the management of symptomatic pancreas divisum.

Background/aims: The efficacy of endoscopic treatment in pancreas divisum remains controversial. This study evaluated the results of an endoscopic sphincterotomy of the minor papilla and temporary transpapillary pancreatic stenting in patients with pancreas divisum.

Methodology: Pancreas divisum was diagnosed in four patients between 1994 and 2004. All patients demonstrated episodes of recurrent upper abdominal and back pain were with a median follow-up period of 14.5 months. One patient was treated by a sphincterotomy of the minor papilla alone, while three others also underwent transpapillary pancreatic stent insertion for seven days.

Results: A Sphincterotomy of the minor papilla could be successfully achieved in all patients. There was no instance of bleeding, perforation or sepsis after the procedure. The postoperative serum amylase level in the patients without stent insertion (1352 IU/L) was higher than that the patients with stents (mean level 515 IU/L, range 358 to 680). The dilatated dorsal pancreatic ducts were found to improve after a sphincterotomy in all patients. None of the patients had any further episodes of pancreatitis. In addition, all patients demonstrated a considerable improvement in their upper abdominal or back pain symptoms, which did not require either analgesic medication or hospitalization.

Conclusions: An endoscopic sphincterotomy and temporary transpapillary pancreatic stenting were therefore suggested to be a beneficial treatment modality for patients with pancreas divisum.