Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD).Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD.Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP).Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12–71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05).Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.

Double plastic stent implantation for recurrent acute pancreatitis with incomplete pancreas divisum: a case report and literature review

Pancreas divisum (PD) is a common pancreatic malformation caused by the failure of fusion between ventral and dorsal pancreatic ducts. There is a small branch of communication between the two systems in incomplete PD, and this variation has an incidence of 15%. A 43-year-old female patient presented to our department with recurrent abdominal pain. Magnetic resonance cholangiopancreatography (MRCP) showed that the ventral pancreatic duct was curved, with a local pouchlike dilatation. Endoscopic ultrasonography supported the diagnosis of incomplete PD and showed a thin branch of communication between ventral and dorsal pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy of the minor papilla with double plastic stent implantation were performed. One pancreatic plastic stent was inserted across the minor and major papilla over the guide wire, creating a U-shape. The other wire-guided plastic stent was inserted through the minor papilla into the dorsal pancreatic duct. The pancreatic fluid drained smoothly after stent placement. During the 6-month follow-up, the patient remained well, without recurrence of pancreatitis.

Pâncreas divisum: relato de caso

Introdução: Pancreas Divisum é uma anomalia anatômica do ducto pancreático em que a maioria do suco pancreático passa pela papila menor e a minoria pela papila maior. Relato de caso: Paciente com 54 anos com Pâncreas Divisumque obteve diagnóstico de pâncreas divisum ocasionalmente durante investigação para elucidação de enzimas hepáticas alteradas e dispepsia. Discussão: Pâncreas Divisum é uma entidade pouco abordada devido à falta de sintomatologia na maioria dos casos, mas há indícios mais recentes que apontam que essa entidade poderia estar relacionada com a maior incidência de outras patologias como pancreatites e tumor pancreático. Conclusão: Por ser uma doença rara e assintomática e, pela possibilidade de evoluir com complicações, deve-se pensar preemptivamente no intuito de prever diagnósticos mais precoces para que se possa intervir em casos de necessidade e evitar desfechos desfavoráveis.

Value of Magnetic Resonance Cholangiopancreatography in Santorinicele and Wirsungocele

Background: Former studies showed that magnetic resonance cholangiopancreatography (MRCP) is useful in diagnosing the presence of santorinicele; however, few studies have evaluated MRCP in diagnosing wirsungocele and the association between pancreatitis and santorinicele or wirsungocele. The purpose of the study was to explore the performance of MRCP in diagnosing santorinicele and wirsungocele and investigate the potential association among pancreatitis, pancreas divisum, and santorinicele or wirsungocele. Method: Seventy-five patients (mean age, 54.6 years; range, 11–82 years) with santorinicele or wirsungocele were included and sorted into two groups: the santorinicele group (n = 57) and the wirsungocele group (n = 18). All patients underwent MRCP. The images were evaluated for the appearance and size of santorinicele or wirsungocele. The diagnostic sensitivity of MRCP was assessed. Additionally, whether two groups are correlated with pancreas divisum or pancreatitis were investigated. Result: The sensitivity of MRCP in detecting santorinicele and wirsungocele showed no difference (70.2% and 77.8%, respectively). The proportion of patients who developed pancreatitis in santorinicele and wirsungocele groups were 59.6% and 11.1%, respectively (p < 0.05). Pancreas divisum accounted for 78.9% and 11.1% of the patients in the santorinicele and wirsungocele groups, respectively (p < 0.05). Patients with santorinicele and pancreas divisum tended to be older when they acquired pancreatitis. Conclusion: MRCP could be an alternative imaging method to detect cystic dilation of the pancreatic duct. Pancreatitis is more common in patients with santorinicele than in those with wirsungocele. Moreover, santorinicele is more closely associated with pancreatitis than with pancreas divisum.