title: Outcome of endotherapy for pancreas divisum in patients with acute recurrent pancreatitis.
abstract: OBJECTIVE
  To assess the rate of relapses of acute pancreatitis (AP), recurrent AP (RAP) and the evolution of endosonographic signs of chronic pancreatitis (CP) in patients with pancreas divisum (PDiv) and RAP.
  
  
  METHODS
  Over a five-year period, patients with PDiv and RAP prospectively enrolled were divided into two groups: (1) those with relapses of AP in the year before enrollment were assigned to have endoscopic therapy (recent RAP group); and (2) those free of recurrences were conservatively managed, unless they relapsed during follow-up (previous RAP group). All patients in both groups entered a follow-up protocol that included clinical and biochemical evaluation, pancreatic endoscopic ultrasonography (EUS) every year and after every recurrence of AP, at the same time as endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  RESULTS
  Twenty-two were treated by ERCP and 14 were conservatively managed during a mean follow-up of 4.5 ± 1.2 years. In the recent RAP group in whom dorsal duct drainage was achieved, AP still recurred in 11 (57.9%) after the first ERCP, in 6 after the second ERCP (31.6%) and in 5 after the third ERCP (26.3%). Overall, endotherapy was successful 73.7%. There were no cases of recurrences in the previous RAP group. EUS signs of CP developed in 57.9% of treated and 64.3% of untreated patients. EUS signs of CP occurred in 42.8% of patients whose ERCPs were successful and in all those in whom it was unsuccessful (P = 0.04). There were no significant differences in the rate of AP recurrences after endotherapy and in the prevalence of EUS signs suggesting CP when comparing patients with dilated and non-dilated dorsal pancreatic ducts within each group.
  
  
  CONCLUSIONS
  Patients with PDiv and recent episodes of AP can benefit from endoscopic therapy. Effective endotherapy may reduce the risk of developing EUS signs of CP at a rate similar to that seen in patients of previous RAP group, managed conservatively. However, in a subset of patients, endotherapy, although successful, did not prevent the evolution of endosonographic signs of CP.
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Di Leo
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Giussani
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Raffaella Alessia
authors.initials: RA
authors.lastname: Zuppardo
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Giulia Martina
authors.initials: GM
authors.lastname: Cavestro
authors.affiliation: Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Teston, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, 20132 Milan, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D018450:Disease Progression; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography; Magnetic resonance cholangiopancreatography with secretin stimulation; Minor papilla endotherapy; Pancreatic stenting