Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic procedure in the management of biliary and pancreatic disorders. Despite advances in ERCP facilities and techniques, pancreatitis remains the most common and feared complication of this procedure. The technical challenges of ERCP could be further compounded by variations in the configuration of the pancreatic ductal system. As a result, the knowledge of these variations and their potential role in the development of post-ERCP pancreatitis (PEP) is essential to any successful risk reduction strategy. This review provides an overview of the anatomy and embryological basis of pancreatic duct variations, as well as explore the different types and prevalence of these variations. Also, we discuss the mechanisms of PEP and provide evidence supporting a link between the variations and PEP using published data
Highlights
BackgroundSince 1968 when William McCune, an obstetrician performed the first procedure, endoscopic retrograde cholangiopancreatography (ERCP) has become an important diagnostic as well as a therapeutic procedure in the management of biliary and pancreatic disorders [1]
Common complications of ERCP include pancreatitis, perforations, post-sphincterotomy bleeding, biliary/pancreatic ductal injuries, cholangitis, cholecystitis as well as cardiopulmonary complications related to anesthesia [5]
This review provides an overview of the anatomy and embryological basis of pancreatic duct variations, as well as explore the different types and prevalence of these variations
Summary
Since 1968 when William McCune, an obstetrician performed the first procedure, endoscopic retrograde cholangiopancreatography (ERCP) has become an important diagnostic as well as a therapeutic procedure in the management of biliary and pancreatic disorders [1]. Aberrant pancreaticobiliary ductal junction formation ensues if the union of the two ducts occurs outside the wall of the duodenum resulting in a long common channel (>15mm) [21] This abnormality has been reported in up to 2.6% of individuals undergoing ERCP [23]. Whether the observation from these studies is largely due to the technical challenges associated with this variation is not clear, minor papilla cannulation and pancreatic sphincterotomy are often performed in a pancreas divisum, both of which independently increase the risk factors of PEP [6]. Univariate analysis of factors associated with PEP development shows no significant association between pancreas divisum and the risk of PEP (P=0.21) It is not clear if this finding is due to the age group of the study population or the effect of a smaller sample size. The authors hypothesized the absence of PEP in these patients may be due to the recurrent pancreatic ductal injection from biliopancreatic reflux, 'desensitizing' the pancreatic duct to contrast injection-associated pancreatic duct injuries, an important predisposing factor for PEP
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