Background: Pancreas divisum (PD) is the most common congenital pancreatic abnormality and is implicated as a cause of recurrent acute pancreatitis (RAP). We report our experience in minor papilla sphincterotomy (MPS) with other endotherapies in its management. Existing literature has not examined MPS as the primary treatment modality in a large and homogenous patient group. Methods: Patients with PD and RAP were identified from an endoscopic database. Chronic pancreatitic pain patients were excluded. Treatment protocol consisted of minor papilla guidewire cannulation followed by sphincterotomy either over the wire or needle-knife cut over a pancreatic stent. A 5Fr stent was placed and left in situ for 1 week. Adjunctive endoscopic therapy was performed as required. Follow-up data was collected via interview with the patient, contact with referring doctors and review of the medical record. Variables collated included time between initial presentation and diagnosis of PD, number of pancreatitis episodes and hospitalisations prior to and after MPS, procedural details and complications. Results: Between 1998 and 2004, 21 patients underwent MPS for PD and RAP (median age=33, range 9-77, males=14). Median time between first presentation and diagnosis of PD was 24 months (range 1-276). Median number of procedures to achieve minor papilla cannulation and MPS was 1 (range 1-3). Secretin was used in 5 patients. Post-procedural complications encountered were pancreatitis (n=2) and post-procedure pain (n=3). Post-MPS stenosis occurred in 2 patients after a median of 11 months. Adjuvant modalities of pancreatic endotherapy in addition to MPS were required in 14 patients: pancreatic duct dilatation (n=9), pancreatic stone extraction (n=7) and ESWL (n=6, median number of sessions=1.5). Complete stone clearance was achieved in 7/7 patients. Median follow-up time was 38 months (range 4-67 months). Median total number of pancreatitis episodes and hospitalisations pre-MPS were 4 and 2 respectively (range 1-20, range 0-5). Post-MPS these were significantly reduced to 0 and 0 respectively (range 0-8 and 0-4. p=0.001 and p=0.0007), with complete abolition of clinical episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with RAP related to PD. Complete clinical resolution occurs in a significant proportion. Treatment is safe and the response is durable. Background: Pancreas divisum (PD) is the most common congenital pancreatic abnormality and is implicated as a cause of recurrent acute pancreatitis (RAP). We report our experience in minor papilla sphincterotomy (MPS) with other endotherapies in its management. Existing literature has not examined MPS as the primary treatment modality in a large and homogenous patient group. Methods: Patients with PD and RAP were identified from an endoscopic database. Chronic pancreatitic pain patients were excluded. Treatment protocol consisted of minor papilla guidewire cannulation followed by sphincterotomy either over the wire or needle-knife cut over a pancreatic stent. A 5Fr stent was placed and left in situ for 1 week. Adjunctive endoscopic therapy was performed as required. Follow-up data was collected via interview with the patient, contact with referring doctors and review of the medical record. Variables collated included time between initial presentation and diagnosis of PD, number of pancreatitis episodes and hospitalisations prior to and after MPS, procedural details and complications. Results: Between 1998 and 2004, 21 patients underwent MPS for PD and RAP (median age=33, range 9-77, males=14). Median time between first presentation and diagnosis of PD was 24 months (range 1-276). Median number of procedures to achieve minor papilla cannulation and MPS was 1 (range 1-3). Secretin was used in 5 patients. Post-procedural complications encountered were pancreatitis (n=2) and post-procedure pain (n=3). Post-MPS stenosis occurred in 2 patients after a median of 11 months. Adjuvant modalities of pancreatic endotherapy in addition to MPS were required in 14 patients: pancreatic duct dilatation (n=9), pancreatic stone extraction (n=7) and ESWL (n=6, median number of sessions=1.5). Complete stone clearance was achieved in 7/7 patients. Median follow-up time was 38 months (range 4-67 months). Median total number of pancreatitis episodes and hospitalisations pre-MPS were 4 and 2 respectively (range 1-20, range 0-5). Post-MPS these were significantly reduced to 0 and 0 respectively (range 0-8 and 0-4. p=0.001 and p=0.0007), with complete abolition of clinical episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with RAP related to PD. Complete clinical resolution occurs in a significant proportion. Treatment is safe and the response is durable.