title: Role of endoscopic sphincterotomy of the minor papilla in pancreas divisum.
abstract: BACKGROUND
  Pancreas divisum (PD) is a common anatomical variant of the pancreatic duct system. Only a little percentage of patients with this altered anatomy develop symptoms: acute recurrent pancreatitis (ARP), chronic pancreatitis (CP) and pancreatic-type pain alone. These have been supposed to arise from an obstruction to outflow of the pancreatic dorsal duct due to a stenosis of the minor papilla. Endoscopic sphincterotomy of the minor papilla (MiES) can be considered an effective treatment for patients with PD and ARP supported by stenosis or obstruction of the minor papilla. On the other hand, the access through the minor papilla is essential for therapeutic pancreatic endoscopy in patients with PD and CP, but the effectiveness of MiES in these patients is extremely controversial.
  
  
  METHODS
  Aim of this brief review has been to evaluate the short and long-term effects of endoscopic pancreatic interventions in patients affected by symptomatic PD who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic sphincterotomy of the minor papilla (MiES). The main literature database was Medline (1966-2013).
  
  
  RESULTS
  Data come from a personal overview of articles emerging from the same search strategy.
  
  
  CONCLUSIONS
  Nowadays, when endoscopic pancreatic drainage is indicated in patient with symptomatic PD, access through the minor papilla (MiP) is required. Therapeutic endoscopic interventions provide less invasive alternatives to the surgical approach.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
authors.forename: M
authors.initials: M
authors.lastname: Zippi
authors.affiliation: Unit of Digestive Endoscopy, Agostino Gemelli Hospital, Catholic University, Rome.
authors.forename: P
authors.initials: P
authors.lastname: Familiari
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
authors.forename: G
authors.initials: G
authors.lastname: Traversa
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
authors.forename: I
authors.initials: I
authors.lastname: De Felici
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
authors.forename: I
authors.initials: I
authors.lastname: Febbraro
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome.
authors.forename: G
authors.initials: G
authors.lastname: Occhigrossi
authors.affiliation: Department of Internal Medicine and Medical Specialties, Gastroenterology Unit, "Sapienza" University, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Severi
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D009203:Myocardial Infarction; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome
keywords: acute recurrent pancreatitis (ARP); chronic pancreatitis (CP); endoscopic minor papilla sphincterotomy (MiES); endoscopic minor papillotomy; pancreas divisum (PD)