Long term follow up of patients with symptomatic pancreas divisum

Pancreas divisum (PD) is asymptomatic in most pts. However, it has been associated with acute relapsing pancreatitis (ARP), chronic pancreatitis (CP) or recurrent attacks of abdominal pain. Long term outcome of symptomatic pancreas divisum remains unclear. The purpose of this study was to define the long term outcome and natural history of this pt population. Methods:We evaluated 24 pts with PD diagnosed by ERCP. 23 pts presented with recurrent episodes of abdominal pain. All pts were interviewed in detail about the type, character and severity of pain. Pain intensity was graded at diagnosis and after follow-up (f/u) on an analog scale from 0-10. Pts were also questioned for history of alcohol use and gallstones. ERCP findings and details of endoscopic treatment and surgery were obtained from hospital records and endoscopy reports. Pain analog scale was compared at diagnosis and the time of last f/u using double tailed "t" test. Results: 24 pts (12 M, 12 F) were included in the study. Mean age was 48.71 (range 10-71 yrs) and mean duration of follow-up was 28.67 mos (range 3-70 mos). 5 pts had CP, 4 had ARP and 14 presented with recurrent abdominal pain. 7 pts underwent endoscopic therapy (Endo Rx) which included minor ampulla sphincterotomy/endoscopic stent placement or both. 2 of these pts subsequently underwent surgery. 3 developed post ERCP pancreatitis (12.5%). 13 pts underwent cholecystectomy although only 6 of these had evidence of gallstones. Endo RX N Pain Scores at Diagnos is After F/U Surg F/U (m) Yes 7*8.8±0.37 2.4±0.68 2**24.14 No 15 4.87±0.7 3.24±0.47 0 31.13*2 additionalpts underwent biliary sphincterotomy;**Distal pancreatectomy. Conclusions: Pain scores diminished significantly after endoscopic treatment (p=0.003). However, 2 pts required surgical therapy after failure of endoscopic treatment. Even in patients who did not receive any treatment, pain scores were significantly lower at f/u (p=0.009) suggesting that the intensity of pain may diminish with time. There appears to be a higher incidence (12.5%) of post ERCP pancreatitis in patients with PD. Prospective studies are needed to confirm these findings.