Surgery for Pancreas Divisum

Keith, Roger G.

doi:10.1016/s1052-5157(18)30465-3

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…A papillotomy of at least 1 cm is performed, with the pancreatic mucosa sutured to the duodenal mucosa in the case of a sphincteroplasty. Keith et al [31] performed transduodenal sphincterotomy alone in their series and claimed similar results. Prophylactic cholecystectomy and sphincterotomy of the major papilla are not generally performed.…”

Section: Dorsal Duct Sphincteroplasty/sphincterotomymentioning

confidence: 74%

Pancreas divisum

Khalid

Slivka

2001

Curr Treat Options Gastro

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We offer endoscopic therapy for pancreas divisum only in patients with acute recurrent pancreatitis or chronic pancreatitis, based on studies delineated in this article, which results in response rates of 80% and 50% respectively. We do not offer endoscopic therapy for patients with chronic abdominal pain in the absence of morphologic abnormalities in the pancreatic duct or parenchyma or normal laboratory study results. It has been our experience that the success rate for endoscopic cannulation and therapy directed at the minor papilla in patients with symptomatic pancreas divisum is improved when the procedure is performed with primary intent to treat in patients who have a pre-existing diagnosis of pancreas divisum, as opposed to patients who undergo diagnostic ERCP for idiopathic acute recurrent pancreatitis and are diagnosed with pancreas divisum during the procedure. We cannulate the minor papilla with ultratapered 3-F catheters and 0.018-in soft wires. It is our opinion that minor papilla sphincterotomy offers advantages over chronic stent therapy in treating patients with pancreas divisum. Although both techniques have proven efficacy, chronic stenting requires repeated procedures and results in a high incidence of stent-induced chronic duct changes, both of which can be avoided by performing a minor papillotomy. We use an ultratapered papillotome with a 20-mm monofilament cutting wire and typically use blended current. The papillotomy is extended to ablate the mucosal mound of the minor papilla typically in a 2-o'clock direction for a distance between 4 and 8 mm, depending on the patient's anatomy. Following minor papillotomy, we place temporary 5-F pancreatic duct stents to reduce the incidence of postprocedural pancreatitis, which has been demonstrated in pancreatic duct sphincterotomy of the major papilla. These stents usually migrate out after 24 to 72 hours following the procedure. We offer surgical sphincteroplasty to patients in whom minor papillotomy cannot be performed or whose disease relapses after successful endoscopic therapy.

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Section: Dorsal Duct Sphincteroplasty/sphincterotomymentioning

confidence: 74%

Pancreas divisum

Khalid

Slivka

2001

Curr Treat Options Gastro

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“…14 Other investigators have noted difficulty documenting changes with this study. 15 Secretin stimulation was not used in patients in our series, and we believe that the small ductal diameter in children may limit the effective use of secretin stimulation in this patient population.…”

Section: Discussionmentioning

confidence: 89%

“…Several investigators have reported epidemiologic studies showing an increased incidence of pancreas divisum in patients undergoing investigations for unexplained pancreatitis. 8 -13 Warshaw et al 14 and Keith 15 have focused on the pathophysiology created by stenosis of the dorsal ductal orifice in patients with several anatomical variants of pancreas divisum and have analyzed predictors of surgical success in this group. Various forms of pancreas divisum have been described, but two common features associated with this anomaly are regularly noted: ductal stenosis either at its ampullary outlet or at a junction point in the ductal system, or localized ductal ectasia, particularly in the uncinate process, which is also usually associated with ampullary stenosis.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Recurrent Pancreatitis in Children With Pancreas Divisum

Neblett

O’Neill

2000

Annals of Surgery

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ObjectiveTo analyze an institutional experience with pancreatitis in childhood to clarify the frequency of pancreas divisum in that patient population, the characteristics of pancreatitis in children with pancreas divisum, and the role of surgical management in their treatment. Summary Background DataThe role of pancreas divisum in causing acute and relapsing pancreatitis and chronic, recurring abdominal pain is controversial. Although the anatomical abnormality is present from birth, most investigators have reported cases with onset of symptoms in adulthood. The reported pediatric experience with this disorder is small, and the natural history of pancreatitis in children with pancreas divisum has not been well elucidated. MethodsA retrospective chart review of all children 18 years of age and younger with a discharge diagnosis of pancreatitis identified 135 patients treated in the authors' institution from 1978 to 1998. Ten patients were found to have anatomical variants of pancreas divisum associated with recurrent or chronic pancreatitis. The medical records of these patients were reviewed for data on the presentation, diagnostic findings, imaging studies, treatment, surgical findings, and pathologic findings in these children. Chart review and telephone calls were used to assess the current state of health in nine patients available for follow-up. ResultsPancreas divisum was identified in 7.4% of all children with pancreatitis and 19.2% of children with relapsing or chronic pancreatitis. Patients had early onset of recurrent episodic epigastric pain and vomiting, at a mean age of 6 years. Three patients had a positive family history of pancreatitis and one was proven by DNA analysis to have hereditary pancreatitis. Pancreatitis was documented by elevated amylase or lipase levels, and endoscopic retrograde cholangiopancreatography was the method of diagnosis of pancreas divisum in all patients. Eight patients had complete pancreas divisum and two had incomplete variants. Eight patients underwent surgery to improve ductal drainage. Seven underwent transduodenal sphincteroplasty of the accessory papilla, along with sphincteroplasty of the major papilla in two (plus septoplasty in one). Three patients underwent longitudinal pancreaticojejunostomy, as a primary procedure in one patient with midductal stenosis and in two because of recurring pancreatitis after sphincteroplasty. The surgical findings and histologic examination of five patients undergoing distal pancreatectomy revealed striking changes of advanced chronic pancreatitis. Patients responding to sphincteroplasty alone showed less severe histologic changes. Overall, three of seven patients had excellent results, three were improved, and one had continued disabling attacks of pancreatitis. The mean duration of follow-up was 7.3 years, and there were no deaths. No patients had endocrine or exocrine pancreatic insufficiency, and none required chronic analgesics. ConclusionsPancreas divisum is an important cause of recurrent pancreatitis in childhood and sho...

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“…Several reports provide evidence suggesting that patients with pancreas divisum benefit from sphincterotomy of the minor papilla [54, 55, 56, 57]. Warshaw et al [55] reported that 70% of patients with pancreas divisum and acute relapsing pancreatitis were relieved of pain after surgical sphincterotomy of the minor (± major) papilla; results were less favorable in patients with chronic pancreatitis.…”

Section: Pancreas Divisummentioning

confidence: 99%

Endoscopic Retrograde Cholangiopancreatography in Chronic Pancreatitis

Bolan¹,

Fink

2003

World j. surg.

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Endoscopic retrograde cholangiopancreatography (ERCP) plays an important diagnostic and therapeutic role in the management of chronic pancreatitis. New techniques are being developed which should further improve outcomes of endoscopic intervention. The ultimate role of these therapeutic interventions for chronic pancreatitis awaits prospective randomized data demonstrating their efficacy and safety in comparison to surgery. Until such time, these often difficult techniques should be performed by experienced endoscopists with significant experience in pancreatic disease, ideally within the context of controlled clinical trials.

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Surgery for Pancreas Divisum

Cited by 12 publications

References 11 publications

Pancreas divisum

Pancreas divisum

Surgical Management of Recurrent Pancreatitis in Children With Pancreas Divisum

Endoscopic Retrograde Cholangiopancreatography in Chronic Pancreatitis

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