3798 Randomized controlled trial of minor papilla stenting in pancreas divisum patients with pancreatic-type pain only.

Abstract

Introduction: Pancreas divisum (PD) is a congenital anomaly caused by failure of fusion of the ventral and dorsal duct systems. A small subset of individuals with PD suffers only from pancreatic-type pain in the absence of clinical pancreatitis. Aim: To evaluate the effectiveness of endoscopic stent placement across the minor papilla in relieving the abdominal pain in patients with PD. Methods: All patients had pancreatic-type pain with no documented episodes of pancreatitis. Patients were randomized to receive either 5 fr stent placement across the minor papilla or sham stent placement. Medical history questionnaire and physical exam were performed at baseline and after each visit. Patients graded the frequency, intensity of the pain and general feeling on scale from 1 to 10. Results: 22 patients were enrolled. 13 patients (77%females) were randomized to receive stent placement (group 1) and 9 patients (89%females) were randomized to receive no stents (group 2). One patient in group 2 was excluded due to inability to cannulate the minor papilla. Mean age,wt/pounds, number of bowel movement/day,duration of pain/month were (42,171,1.3,55) in group 1 and were (43, 172,2,60)in group 2. Mean pretherapy abdominal frequency, intensity and general feeling in group 1 were (6,6.1,5.3) and (6.5,6.9,6.25) in group 2. The differences in the pretherapy frequency Φ,intensity (I) and general feeling (G)between both groups were not significant (P=0.44,P=0.17,P=0.14). Mean post-therapy abdominal F, I and G in group 1 were (4.6,4.7,4.5) and (5.2,5.8,5.3) in group 2. The differences in the post-therapy F,I and G between both groups were not significant (P=0.5,P=0.2,P=0.28). Grading of pre and post abdominal pain in each group shows no differences in F,I and G. Conclusion: Minor papilla stenting offers no benefit in the management of pancreas divisum patients with pancreatic-type pain only. Pain response to stent placement and no stent Pain Improvement No improvement Stent 5 (38.5%) 13 No stent 2 (29%) 7 p >0.35