Accessory sphincterotomy (endoscopic and surgical) in patients with pancreas divisum

Russell, R. C. G.; Wong, Neil; Cotton, Peter B.

doi:10.1002/bjs.1800711214

Cited by 62 publications

(15 citation statements)

References 11 publications

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“…33,34 On the other hand, arguments against such a causal association are: (i) PD is asymptomatic in the vast majority of individuals, [35][36][37] (ii) there is no significant difference in the prevalence of PD between the pancreatitis and non-pancreatitis patient groups in a large series of patients undergoing ERCP, 38 and (iii) the response to minor papilla sphincterotomy is variable and suboptimal in the majority of patients presenting with RAP and CP. 39,40 The prevalence of PD in RAP varies across various studies (Table 6). 25,[35][36][37][41][42][43] A recent community-based study from Japan included 504 subjects from the general population, and 46 patients with pancreatitis (8 AP, 23 CP and 15 RAP).…”

Section: Pancreas Divisum (Pd)mentioning

confidence: 99%

Recurrent acute pancreatitis: an approach to diagnosis and management

Kedia¹,

Dhingra²,

Garg³

2013

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Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%- In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

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Section: Pancreas Divisum (Pd)mentioning

confidence: 99%

Recurrent acute pancreatitis: an approach to diagnosis and management

Kedia¹,

Dhingra²,

Garg³

2013

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“…Good results arc observed in only 53% of the cases [22][23][24][25]. Surgical treatment (sphincteroplasty of the accessory papilla, pancreatic resection and/or drain age) leads to good results in about 70% of the cases [17,18,21 ] but follow-up is limited in most studies.…”

Section: Pd: Accessory Papilla Stenosis?mentioning

confidence: 99%

Pancreas divisum: Controversial Clinical Significance

Delhaye

Engelholm²,

Cremer³

1988

Dig Dis

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“…Multiple surgical and endoscopic drainage procedures have been performed to treat these conditions based on the hypothesis that the minor papilla is too small to accommodate the volume of pancreatic secretion. In an early report, endoscopic sphincterotomy of the minor papilla proved to be technically difficult, with a successful outcome in only 5 of 12 patients, and ineffective, with a good outcome in only patient (16). The data for surgical treatment, drawn from a small number of series reported by a few surgeons, show a good outcome in 74% to 93% of patients with pancreatitis after sphincteroplasty or sphincterotomy of the minor papilla.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Stenting and Sphincterotomy of the Minor Papilla in Symptomatic Pancreas Divisum: Results and Complications

Cohen

Rutkovsky

Siegel

et al. 1994

Diagnostic and Therapeutic Endoscopy

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Pancreas divisum has been postulated as a cause of acute pancreatitis and a chronic pain syndrome in a small subgroup of patients and can be treated with endoscopic dorsal pancreatic duct stent placement and minor papilla sphincterotomy. Twenty patients (9 with at least one attack of idiopathic pancreatitis, and 11 with severe pancreatic-type pain) were treated endoscopically. Dorsal duct stents were placed in 19 patients with subsequent needle knife sphincterotomy of the minor papilla over the stent. Clinical response was judged by comparison of symptoms (using a 0-to-l0 scale and the patient' s overall assessment). The symptom score improved from 9.3 to 5.1 in the pancreatitis group and from 9.3 to 5.7 in the pain group. A good clinical response was observed in 3 of 7 patients in the pancreatitis group and in 6 of in the pain group at a mean follow-up of 22 months. Complications of sphincterotomy were limited to pancreatitis in 6 patients (29%), 5 mild and moderate according to published criteria. No patient required more than 4 days hospitalization. Two of 39 stents migrated into the pancreas, and another stent fractured and remained lodged in the pancreas. Eight of 9 patients evaluated demonstrated new morphologic duct changes on follow-up pancreatograms. Endoscopic stenting and sphincterotomy of the minor papilla are feasible and may be effective in some patients with pancreas divisum but carries a significant complication rate. The subjective improvement in patients with chronic pain wan'ants further controlled study.

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Accessory sphincterotomy (endoscopic and surgical) in patients with pancreas divisum

Cited by 62 publications

References 11 publications

Recurrent acute pancreatitis: an approach to diagnosis and management

Recurrent acute pancreatitis: an approach to diagnosis and management

Pancreas divisum: Controversial Clinical Significance

Endoscopic Stenting and Sphincterotomy of the Minor Papilla in Symptomatic Pancreas Divisum: Results and Complications

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