Ultimos adelantos: diagnóstico y tratamiento del pancreas divisum.

Translated title of the contribution: State-art: diagnosis and management in pancreas divisum

Panot Yimcharoen, Evan Fogel, Lee McHenry, James Watkins, Stuart Sherman, Glen Lehman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Pancreas divisum (PD), the most common congenital variant of pancreatic duct anatomy, occurs when the ductal systems of the ventral and dorsal pancreatic ducts fail to fuse during the second month of gestation. With non-union of the ducts, the major portion of the pancreatic exocrine secretion enters the duodenum by way of the dorsal duct and minor papilla. It has been generally accepted that a relative obstruction to pancreatic exocrine secretory flow through the minor duct and minor papilla could result in pancreatitis in small numbers of patients with PD. The debate whether PD causes pancreatitis continues, although most authorities agree that PD is a definite cause in a subgroup of patients. Most patients with PD and well-documented acute recurrent pancreatitis have responded favorably to surgical sphincteroplasty of the minor papilla. Endoscopic retrograde cholangiopancreatography (ERCP) is the most common procedure for diagnosis PD in patients who have pancreatobiliary symptoms. MRCP is being increasingly used to establish the diagnosis and secretin stimulation can improve ductal images greatly. Endoscopic management of symptomatic patients with PD is evolving. Only a limited number of series are available, using endoscopic pancreatic stent placement, minor papilla endoscopic papillotomy, or both to decompress the dorsal duct in an effort to restore pancreatic exocrine secretory flow. Even with relatively small numbers of patients and a near absence of controlled, randomized trials, it appears that the patients most likely to benefit, as with surgery, are those with well-documented ARP rather than pain alone or chronic pancreatitis. Overall we recommend that pancreatic stenting and pancreatic sphincterotomy should be done only in large centers with experience in therapeutic ERCP. Further randomized trials would be of interest.

Original languageSpanish
Pages (from-to)133-140
Number of pages8
JournalRevista de gastroenterología de México
Volume70 Suppl 1
StatePublished - Jul 2005

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Art
Pancreas
Pancreatitis
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Endoscopic Sphincterotomy
Secretin
Chronic Pancreatitis
Duodenum
Stents
Anatomy
Randomized Controlled Trials
Pain
Pregnancy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Ultimos adelantos : diagnóstico y tratamiento del pancreas divisum. / Yimcharoen, Panot; Fogel, Evan; McHenry, Lee; Watkins, James; Sherman, Stuart; Lehman, Glen.

In: Revista de gastroenterología de México, Vol. 70 Suppl 1, 07.2005, p. 133-140.

Research output: Contribution to journalArticle

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