Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum

Henning Gerke; Michael F Byrne; Helen L Stiffler; Jorge V Obando; Robert M Mitchell; Paul S Jowell; Malcolm S Branch; John Baillie

Journal article

Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum

Henning Gerke, Michael F Byrne, Helen L Stiffler, Jorge V Obando, Robert M Mitchell, Paul S Jowell, Malcolm S Branch and John Baillie

Journal of the Pancreas, Vol.5(3), pp.122-131

05/2004

PMID: 15138333

View Online

Abstract

Pancreas divisum has been associated with recurrent acute pancreatitis, chronic abdominal pain without elevated pancreatic enzymes, and chronic pancreatitis. Prior studies suggest that endoscopic minor papillotomy benefits certain symptomatic pancreas divisum patients. However, the data are quite limited and there is a lack of long-term follow-up. To describe a retrospective study of endoscopic minor papillotomy for pancreas divisum. Eighty-nine adult patients who underwent endoscopic minor papillotomy at our referral center were included in the study. Median follow-up was 29 months. We conducted a telephone survey. Fifty-three patients were available for the telephone survey. Thirty-two patients (60.4%) reported immediate improvement: however, symptoms recurred in 17 (53.1% of the immediate responders). Repeat endoscopic interventions were performed in 8 patients, with long-term improvement in two. Overall long-term improvement was achieved in 17 patients (32.1%). Results of minor papillotomy were more favorable for patients with recurrent, well-defined bouts of pancreatitis (immediate improvement: P=0.036; long-term improvement: P=0.064) compared to those with pancreatitis who reported continuous pain and those without clinical evidence of pancreatitis (immediate improvement: 73.3%, 42.9% and 44.4%, respectively; long-term improvement: 43.3%, 21.4%, and 11.1%, respectively). The long-term benefit from endoscopic minor papillotomy using strict criteria is poorer than suggested from previous studies. However, pancreas divisum patients with well-defined bouts of pancreatitis are more likely to benefit from endoscopic minor papillotomy than those without symptom-free intervals between "attacks" and those with pain that is not associated with elevated pancreatic enzymes.

Acute Disease

Abdominal Pain - etiology

Follow-Up Studies

Pancreatitis - etiology

Humans

Middle Aged

Male

Treatment Outcome

Sphincterotomy, Endoscopic - adverse effects

Pancreatitis - surgery

Pancreas - surgery

Pancreas - abnormalities

Sphincterotomy, Endoscopic - methods

Adolescent

Adult

Female

Aged

Retrospective Studies

Abdominal Pain - surgery

Chronic Disease

Postoperative Complications

Stents

Details

Title: Subtitle: Outcome of endoscopic minor papillotomy in patients with symptomatic pancreas divisum
Creators: Henning Gerke - Department of Medicine, Division of Gastroenterology, Duke University Medical Center. Durham, North Carolina 27705, USA. gerke003@notes.duke.edu
Michael F Byrne
Helen L Stiffler
Jorge V Obando
Robert M Mitchell
Paul S Jowell
Malcolm S Branch
John Baillie
Resource Type: Journal article
Publication Details: Journal of the Pancreas, Vol.5(3), pp.122-131
PMID: 15138333
ISSN: 1590-8577
eISSN: 1590-8577
Language: English
Date published: 05/2004
Academic Unit: Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9984094732002771

Metrics

14 Record Views