Pancreas divisum: a reemerging risk factor for pancreatic diseases

Early Chronic Pancreatitis Findings by Endoscopic Ultrasonography (EUS) in Asymptomatic Patients with Pancreas Divisum

Background/Objectives: Pancreas divisum (PD) is a congenital malformation associated with chronic and recurrent acute pancreatitis. Although PD often presents asymptomatically, the extent to which early chronic pancreatitis (ECP) changes occur in asymptomatic patients with PD remains unclear. This study aimed to evaluate endoscopic ultrasonography (EUS) findings indicative of ECP in asymptomatic patients with PD and investigate the relationship between these findings and background factors, such as age, sex, main pancreatic duct diameter, and alcohol intake. Methods: We retrospectively analyzed 17 asymptomatic patients diagnosed with PD at the Showa University Fujigaoka Hospital between January 2016 and May 2024. EUS was used to assess the pancreatic parenchyma and ductal features, and the findings were classified according to the Rosemont Classification (RC) and the Japan Pancreas Society (JPS) 2019 criteria for ECP (JDCECP2019). Statistical analyses were performed to examine the association between EUS findings and patient background factors. Results: EUS findings of ECP were observed in 8 of 17 asymptomatic patients with PD (47%) according to both the RC and the JDCECP2019 criteria. Hyperechoic foci without shadowing or strands were the most common findings, present in 82% of the patients. No significant associations were found between EUS findings and the background factors of age, sex, main pancreatic duct diameter, or alcohol intake. Conclusions: A considerable proportion of asymptomatic patients with PD exhibited EUS findings suggestive of early chronic pancreatitis. These findings indicate that early changes in chronic pancreatitis may be accompanied by asymptomatic PD.

New frontiers in ectopic pancreatic tissue management

The pancreatic development variations are relatively frequent but are often overlooked in clinical practice. This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic. It also refers to the ectopic pancreatic tissue in the stomach. This anomaly can be diagnosed in any part of the digestive system, but it is mostly seen in the upper gastrointestinal tract, especially in the stomach, duodenum and jejunum. The management of this condition has evolved due to the development of minimally invasive procedures.

Metastatic Melanoma Invading the Minor Duodenal Papilla in a Patient With Pancreas Divisum Causing Acute Recurrent Pancreatitis: A Case Report

Metastasis to the gastrointestinal (GI) tract should always be a consideration when melanoma, particularly metastatic disease, is diagnosed. While metastasis to the small intestine is common, given its rich blood supply, metastasis to the pancreatic ducts is extremely rare. In patients with pancreatic divisum, disease spread to the minor papilla can greatly increase the chance of developing pancreatitis due to the potential for increased pancreatic intraductal pressure. We present one unique case of metastatic melanoma to the minor duodenal papilla causing pancreatitis.

Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD). Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD. Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP). Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12-71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05). Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.