Endoscopic therapy in children with pancreas divisium presenting with acute pancreatitis or chronic abdominal pain

Abstract

Pancreas divisum is the most common congenital anomaly of the pancreas, potentially resulting in a relative outflow obstruction across a stenotic minor papilla. As a result of this drainage deficiency, patients are predisposed to acute pancreatitis or chronic pancreatic-type pain. Endoscopic stent placement or sphincterotomy of the minor papilla has been shown to be beneficial in reducing abdominal pain as well as episodes of pancreatitis in a subset of adult patients with pancreas divisum and acute recurrent pancreatitis (ARP). The significance of pancreas divisum in children presenting with ARP or chronic abdominal pain is unknown. AIM: To determine the efficacy of endoscopic sphincterotomy or stent therapy of the minor papilla in children with pancreas divisum associated with ARP or chronic abdominal pain. METHODS: 16 patients (5M, llF, age range 13-17, mean 15.6 yrs), presented With pancreas divisum and ARP (10), chronic pain (3), or chronic pancreatitis (3). Treatment consisted of pancreatic stent across the minor papilla, 3 exchanges over a 9 month period (13) or minor papilla sphincterotomy (3). Patients were evaluated for recurrent episodes of pancreatitis and/or presence of abdominal pain at each retum visit and at the end of the study by interview. RESULTS: All patients underwent successful pancreatography with subsequent therapy, stent placement (7 French) or sphincterotomy. Endoscopic therapy was successful in 8 of 10 patients (80%) presenting with ARP whereas only 33% of patients with chronic pain only or chronic pancreatitis (CP) had successful treatment outcome.