The efficacy of endoscopic therapy for pancreas divisum: a meta-analysis

Abstract

BackgroundThe purpose of this study was to perform a meta-analysis assessing the efficacy and predictors of success of endoscopic therapy in the management of patients with pancreas divisum.MethodsAn electronic database search (PubMed and ScienceDirect) was performed for relevant studies. Studies were selected based on predefined criteria and data were extracted on patient population, follow up, endotherapy methods, success rates and complication rates. A random-effect model was used to pool the effect size across studies. Heterogeneity testing and publication bias assessment were performed. Multivariate regression analysis was performed to identify predictors of successful endoscopic therapy.ResultsOf 381 articles reviewed, 23 studies with 874 patients met the inclusion criteria. All were case series with suboptimal quality. Endoscopic therapy included minor papilla sphincterotomy, minor papilla sphincteroplasty and dorsal duct stenting. Mean follow-up duration was 37 months. The rate of “improvement” as defined by authors after endoscopic therapy varied significantly across studies, ranging from 31-96%: 589/874 patients were reported to have improved, corresponding to a pooled efficacy rate of 67.5% (95% confidence interval [CI] 0.610-0.734; P=0.0001). The pooled rate of pancreatitis after endoscopic retrograde cholangiopancreatography was 10.1% (95%CI 0.084-0.124; 2-sided P=0.0001). On subgroup analysis, patients with recurrent acute pancreatitis had better endoscopic outcomes (pooled efficacy rate 76%, 95%CI 0.712-0.803, P=0.0001). Dorsal duct stenting and longer follow up were the only parameters predictive of successful endotherapy. Significant heterogeneity was observed within and across studies.ConclusionsEndoscopic efficacy in pancreas divisum is estimated at 67.5%. Available studies are of poor quality with significant heterogeneity. Comparative studies with rigorous methodology are needed.

Identification and management of pancreas divisum

“…This study demonstrated significant objective and subjective clinical improvement of symptoms with endotherapy compared with controls on short-term follow-up. Four systematic reviews and meta-analyses of these studies[6, 123, 124, 125] reporting a pooled response rate of 62–70%. The maximal improvement of symptoms was seen in patients with recurrent acute pancreatitis (76–80%), with a lower response rate in chronic pancreatitis (42–69%), and the least with chronic pancreatic-type abdominal pain (33–54%).…”

Pancreas divisum: a reemerging risk factor for pancreatic diseases

“…Dorsal duct stenting and longer follow up were the only parameters predictive of successful therapy. The pooled rate of pancreatitis after endoscopic retrograde cholangiopancreatography was 10.1% (95%; CI 0.084-0.124; p = 0.0001) [83].…”

Acute recurrent and chronic pancreatitis in children

“…In adult patients with symptomatic pancreas divisum, therapeutic ERCP, including minor papilla sphincterotomy, dorsal duct stenting, and minor papilla balloon dilation, has been utilized frequently 93,94 . Endoscopic efficacy in pancreas divisum is estimated at 67.5% (ranging from 31.3% to 95.7%) 93 . Recently, Wen et al .…”