Retrospective Study
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World J Gastroenterol. Dec 14, 2014; 20(46): 17468-17475
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17468
Outcome of endotherapy for pancreas divisum in patients with acute recurrent pancreatitis
Alberto Mariani, Milena Di Leo, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Antonella Giussani, Raffaella Alessia Zuppardo, Giulia Martina Cavestro, Pier Alberto Testoni
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
Author contributions: Mariani A contributed to design of the study, interpretation data, drafting the manuscript, critical review and final approval of the version to be published; Di Leo M, Petrone MC, Aricidiacono PG, Giussani A, Zuppardo RA and Cavestro GM contributed to patients recritment, interpretation data, drafting the manuscript, and final approval of the version to be published; and Testoni PA contributed to design of the study, interpretation data, drafting the manuscript, critical review and final and final approval of the version to be published.
Correspondence to: Alberto Mariani, MD, Gastroenterology and Gastrointestinal Endoscopy Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute - Vita Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy. mariani.alberto@hsr.it
Telephone: +39-2-26432756 Fax: +39-2-26435609
Received: January 28, 2014
Revised: May 9, 2014
Accepted: July 24, 2014
Published online: December 14, 2014
Processing time: 323 Days and 22.1 Hours
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Endoscopic retrograde cholangiopancreatography; Magnetic resonance cholangiopancreatography with secretin stimulation; Minor papilla endotherapy; Pancreatic stenting; Endoscopic ultrasonography

Core tip: In this paper we compared the outcome of patients with pancreas divisum (PDiv) and recent or previous recurrent acute pancreatitis (RAP) after minor papilla endotherapy or observation, respectively. We confirmed previous findings regarding the benefit of endotherapy in patients with PDiv and RAP. In addition, we showed that effective endotherapy in patients with recent bouts of pancreatitis reduced the risk of developing endoscopic ultrasonography signs of chronic pancreatitis (CP) at a rate similar to that seen in patients without recent episodes of acute pancreatitis who are managed conservatively. However, in a subset of patients, endotherapy, although successful, did not prevent the evolution of endosonographic signs of CP.