What is the clinical importance of pancreas divisum? @my_ueg #UEGambassador @aegastro @EurPancClub @hpb_so @me4_so #EndoSoMe @SEEDendoscopia #PancreasHGUA @DHgua #Pancreatitis
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Pancreas divisum (PD) is the most frequent embryological abnormality of the pancreas: in a MRI study on almost 1,000 volunteers, 9.6% of them had PD variants. Maybe you have a PD!! ncbi.nlm.nih.gov
Pancreas divisum results from the failed fusion of the dorsal and ventral pancreatic ducts during gestation. A small ventral duct drains pancreatic juice from the head through the major papilla and a huge dorsal duct drains the rest through the minor papilla #UEGambassador
Pancreas divisum may be complete (no connection between dorsal and ventral duct), incomplete (dominant dorsal d. connected with the ventral d.),a dominant dorsal d. may be present without a ventral d. or a dominant ventral d. may be associated to a little dorsal d. #UEGambassador
Some observational studies suggested that pancreas divisum was associated to acute and chronic pancreatitis. It has been hypothesized that PD is associated to a functional obstruction, as most of the pancreatic juice is drained through the minor papilla karger.com
A 1992 trial randomized patients with recurrent acute pancreatitis and pancreas divisum to endoscopic dorsal duct stent placement or observation.Stenting resulted in significant clinical improvement. We do not have further evidence from RCTs #UEGambassador giejournal.org
Some studies have detected an interaction between pancreas divisum, genetic mutations associated to pancreatitis and the development of pancreatitis, are genetic mutations a confounder or a cofactor together with pancreas divisum? #UEGambassador insights.ovid.com
According to a recent meta-analysis "Endoscopic 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" ncbi.nlm.nih.gov
To complicate things further, pancreas divisum has been linked to pancreatic tumors, although the evidence is scarce and no conclusion can be drawn #UEGambassador sciencedirect.com
If you want to know more, this is a nice review about endotherapy in recurrent pancreatitis: Guo et al, The Role of Endotherapy in
Recurrent Acute Pancreatitis sciencedirect.com
Recurrent Acute Pancreatitis sciencedirect.com
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