title: Endotherapy in symptomatic pancreas divisum: a systematic review.
abstract: Pancreas divisum (PD) is the most common congenital variant of the pancreas and has been implicated as a cause of pancreatitis; however, endoscopic treatment is controversial. Our objective was to examine patient response to endotherapy for treatment of symptomatic PD in adult patients in a systematic review of the literature. A systematic review of all case series and case-control studies with ten or more patients undergoing endotherapy for treatment of symptomatic PD indicated by acute recurrent pancreatitis (ARP), chronic pancreatitis (CP), or chronic abdominal pain (CAP) was performed. PubMed, Embase, and Web of Science databases were searched from inception through February 2013 using [pancreas divisum] AND [endoscopic retrograde cholangiopancreatography (ERCP)] OR [endotherapy] OR [endoscopy] as search terms. Importantly, the majority of studies were retrospective in nature, significantly limiting analysis capacity. Main outcomes measures included endotherapy response rate in patients with PD and ARP, CP, or CAP. Twenty-two studies were included in the review, with a total of 838 patients. Response to endoscopy was seen in 528 patients, but response rate varied by clinical presentation. Patients with ARP had a response rate ranging from 43% to 100% (median 76%). Reported response rates were lower in the other two groups, ranging from 21% to 80% (median 42%) for patients with CP and 11%-55% (median 33%) for patients with CAP. Complications reported included perforation, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, and clogged stents. Endotherapy appears to offer an effective treatment option for patients with symptomatic PD, with the best results in patients presenting with ARP.
authors: Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
authors: Rajan
authors: R
authors: Kanth
authors: Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
authors: N Swetha
authors: NS
authors: Samji
authors: Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
authors: Anupama
authors: A
authors: Inaganti
authors: Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
authors: Sarah D
authors: SD
authors: Komanapalli
authors: Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA.
authors: Ramon
authors: R
authors: Rivera
authors: Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA.
authors: Mainor R
authors: MR
authors: Antillon
authors: Department of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, LA, USA; Department of Gastroenterology, Marshfield Clinic, Marshfield, WI, USA. Electronic address: proy@phs.org.
authors: Praveen K
authors: PK
authors: Roy
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery*; D010182:Pancreatic Diseases / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery; D016717:Sphincterotomy, Endoscopic
keywords: Cholangiopancreatography; Chronic/diagnosis/therapy; Congenital abnormalities/epidemiology; Endoscopic retrograde; Pancreas/abnormalities; Pancreatitis/complications