Prospective study on outcomes of endotherapy for pancreatic divisum in patients of recurrent acute pancreatitis.

Abstract

Background and study aims: Minor papilla endotherapy success rate is highly variable for pancreatic divisum (PD) among recurrent acute pancreatitis (RAP) patients due to frequent relapses. Therefore, we assessed effectiveness and predictors of successful endotherapy.

Patients and methods: This was a prospective observational study of patients with RAP who underwent minor papilla sphincterotomy and prophylactic stenting for PD. Technical success was minor papilla cannulation and successful procedure completion. Primary and secondary outcomes were improvement in recurrent episodes of pain with reduction in visual analogue scale (VAS) score > 50% from baseline and occurrence of chronic pancreatitis (CP) at 12 months, respectively. Predictors of success were assessed by logistic regression.

Results: Ninety-four patients, with median age (interquartile range) 29.5 years (23.7-40.2); the majority male (62 [65.9%]), successfully underwent endotherapy. Typical clinical presentation was abdominal pain in 87 patients (92.5%). The primary outcome was achieved in 65 patients (69.1%). The average number of endoscopic retrograde cholangiopancreatography (ERCP) sessions was two; technical success was achieved in 88 patients (93.6%). Post-ERCP pancreatitis was the most common adverse event (AE) in 10 patients (10.6%). Signs of CP were seen in 11 patients (11.7%) and mean follow-up period was 12.8 ± 1.3 months. Presence of smoking (adjusted odds ratio [AOR] 0.027, P = 0.001) and recurrent attacks of RAP after index ERCP (AOR 0.169, P < 0.001) had lower odds of successful endotherapy outcomes.

Conclusions: Minor papilla endotherapy for RAP significantly improved VAS scores at 12 months among 69.1% of patients with acceptable AEs. Early CP was seen in 11.7% of patients. (Unique identifier: CTRI/2019/05/019332).