Endoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial

Lans, Jonathan; Geenen, Joseph E.; Johanson, John F.; Hogan, Walter J.

doi:10.1016/s0016-5107(92)70471-4

Cited by 237 publications

(88 citation statements)

References 12 publications

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“…Endoscopic therapy consists of minor papilla sphincterotomy with or without stenting ( Table 8). 33,[89][90][91][92][93][94][95] The efficacy of endoscopic therapy has varied from 50% to 90%. [94][95][96][97][98] Surgical sphincteroplasty has also shown an overall success rate of ~80%.…”

Section: Phase II Investigationsmentioning

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: Phase II Investigationsmentioning

confidence: 99%

Recurrent acute pancreatitis: an approach to diagnosis and management

Kedia¹,

Dhingra²,

Garg³

2013

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“…In pancreas divisum, putative outflow obstruction from the larger dorsal part of the gland may be improved by stent placement across the minor papilla, which is particularly effective in a subgroup of patients with acute recurrent pancreatitis. 6 Other indications for pancreatic stenting are ductal disruption and treatment of pancreatic ascites and pleural effusion, as well as draining of pseudocysts communicating with the pancreatic duct. 5, 7, s A major limitation of the use of pancreatic stents is stent occlusion, which causes recurrence of symptoms and necessitates repeated stent exchanges.…”

mentioning

confidence: 99%

Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis

Smits

Groen²,

Mok³

et al. 1997

Gastrointestinal Endoscopy

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Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis Smits, M.E.; Groen, A.K.; Mok, K.S.; van Marle, J.; Tytgat, G.N.J.; Huibregtse, K. Published in:Gastrointestinal endoscopy Link to publicationCitation for published version (APA): Smits, M. E., Groen, A. K., Mok, K. S., van Marle, J., Tytgat, G. N. J., & Huibregtse, K. (1997). Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis. Gastrointestinal endoscopy, 45, 52-58. General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Background: Pancreatic stents may occlude with time, and there is little information available on the nature of the clogging process. Methods: We analyzed the contents of occluded pancreatic polyethylene stents in nine patients with chronic pancreatitis. In the same patients, the protein patterns in the corresponding pancreatic juices were analyzed. The stents had been in place for a mean of 9 weeks (range 2 to 17). Results: All stents were occluded at both ends, especially around side holes, with thick creamy-white precipitate. The average dry weight of occluding debris was 3 mg per 3.25 cm 10F stent. Total protein content was 50% (SD 16.3) and total calcium 0.8% of dry weight (SD 0.6). Light microscopy showed that proteinaceous material completely filled the stent lumen. Yeasts and plant material were seen in two stents. A variable number of bacteria of mixed species, sometimes in clumps, were patchily scattered in the protein matrix. Cultures of stent contents grew several species of Gram-positive and negative bacteria. Scanning and transmission electron microscopy showed an amorphous protein matrix in all stents, arranged as a network in some areas, but in layers in other areas. Sodium dodecylsulfate polyacrimide gel electrophoresis showed that protein patterns of stent contents were remarkably different from the protein patterns of the juice samples of the same patient. A 66 kD band, identified as albumin, appeared in the protein patterns of stent content, whereas it was lacking in most juice samples. Conclusions: Adherence of protein, especially albumin, plays an important role in the process of pancreatic stent clogging. Other factors, such as bacteria, refluxed duodenal contents, and calcium seem to be of less importance.

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“…In 1 study that included 19 patients, the rate of improvement (indicated by reductions in hospital admissions, emergency department visits and episodes of pancreatitis) during a 2-year follow-up period was higher among patients who received a stent than among those who did not (90% v. 11%). 12 Following endoscopic sphincterotomy of the minor papilla in 52 patients with pancreas divisum, improved symptoms were reported more frequently among patients with acute recurrent pancreatitis than among those with chronic pancreatitis (76.5% v. 27.3%) or chronic pancreatic pain (76.5% v. 26.1%) over a mean follow-up of 1.7 years. 13 Surgical resection of the pancreas or drainage procedures can be performed for patients with incapacitating pain if conservative measures fail.…”

Section: Managementmentioning

confidence: 95%

Pancreas divisum: a cause of idiopathic acute pancreatitis

Tarabain²

2009

Canadian Medical Association Journal

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A previously healthy 23-year-old woman presented to hospital with 2 months of intermittent dyspepsia following meals and acute-onset epigastric pain, nausea and vomiting. Based on the results of laboratory investigations (lipase > 1900 [normal < 286] U/L), acute pancreatitis was diagnosed. It was treated conservatively with analgesics and intravenous hydration. The results of other laboratory tests, including those for amylase, leukocytes and creatinine, were within normal limits. No obvious reversible causes of pancreatitis were initially identified. The patient reported consuming alcohol rarely. Ultrasonography of the abdomen ruled out gallstones. A computed tomography (CT) scan of her abdomen and pelvis showed that her pancreas had a relatively normal appearance; however, assessment was limited because of minimal intra-abdominal fat in her upper abdomen in the region of the pancreatic head. After 2 days, the patient's pain had improved but her lipase level remained above 500 U/L. The patient's abdominal pain and lipase levels (829 U/L) increased after she resumed eating solid foods.Ultrasonography performed 21 days after admission showed gallbladder "sludge" with no evidence of stones.Laparoscopic cholecystectomy was performed. The results of tests for autoimmune pancreatitis (antinuclear antibodies and IgG subtypes) were negative. However, the patient had persistent abdominal pain and an elevated lipase level above 1000 U/L. Twenty-eight days after admission, she underwent magnetic resonance cholangiopancreatography, which showed pancreas divisum. Following endoscopic retrograde cholangiopancreatography (Figure 1), a sphincterotomy on the major papilla was performed with no noteworthy clinical improvement. Six weeks later, endoscopic retrograde cholangiopancreatography was repeated, with sphincterotomy of the minor papilla and placement of a stent. The patient's pain resolved, and her lipase levels returned to normal within 14 days. Discussion Anatomy and epidemiologyIn over 90% of healthy people, the dorsal and ventral endodermal pancreatic buds fuse to form the adult pancreas. However, in about 10% of the population, fusion does not occur, resulting in pancreas divisum (Figure 2), which is the most common congenital ductal anomaly of the pancreas. 1 The classic anatomy of pancreas divisum consists of a small ventral duct, which drains through the larger major papilla, and the larger dorsal duct, which drains through the smaller minor papilla. 2,3In patients with a large dorsal duct, the majority of the pancreatic secretions (up to 2000 mL daily) pass through this duct.2 Pancreas divisum through the minor papilla (instead of the major papilla) can result in inadequate drainage and pain Key points• Pancreas divisum is a congenital anomaly that occurs in about 10% of the population and is a potentially treatable cause of acute pancreatitis.• The lifetime risk of pancreatitis for patients with pancreas divisum (5%-10%) is similar to risk in the general population.• Pancreas divisum should be considered in pa...

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Endoscopic therapy in patients with pancreas divisum and acute pancreatitis: a prospective, randomized, controlled clinical trial

Cited by 237 publications

References 12 publications

Recurrent acute pancreatitis: an approach to diagnosis and management

Recurrent acute pancreatitis: an approach to diagnosis and management

Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis

Pancreas divisum: a cause of idiopathic acute pancreatitis

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