Pancreas Divisum

Anatomic variants in PANCREATIC DUCTS characterized by failure of fusion of the ventral and dorsal endodermal buds. Pancreas divisum results in inadequate or no communication between dorsal and ventral ducts. While most cases are asymptomatic, it may be associated with recurrent PANCREATITIS.

Also Known As:

Divisum, Classic Pancreatic; Divisum, Complete Pancreas; Divisum, Complete Pancreatic; Divisum, Incomplete Pancreas; Divisum, Incomplete Pancreatic; Divisum, Inverted Pancreas; Divisum, Pancreas; Divisum, Pancreatic; Divisum, Reverse Pancreas; Divisum, Reverse Pancreatic; Pancreas Divisum, Classic; Pancreas Divisum, Complete; Pancreas Divisum, Incomplete; Pancreas Divisum, Inverted; Pancreas Divisum, Reverse; Pancreas Divisums; Pancreatic Divisum, Classic; Pancreatic Divisum, Complete; Pancreatic Divisum, Incomplete; Pancreatic Divisum, Reverse; Pancreatic Divisums; Classic Pancreas Divisum; Classic Pancreatic Divisum; Complete Pancreas Divisum; Complete Pancreatic Divisum; Dominant Dorsal Duct Syndrome; Incomplete Pancreas Divisum; Incomplete Pancreatic Divisum; Inverted Pancreas Divisum; Pancreatic Divisum; Reverse Pancreas Divisum; Reverse Pancreatic Divisum

Networked: 249 relevant articles (19 outcomes, 14 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Pancreatitis
2.	Pain (Aches)
3.	Chronic Pancreatitis
4.	Abdominal Pain (Pain, Abdominal)
5.	Pathologic Constriction (Stenosis)

Experts

1.	Sherman, Stuart: 7 articles (11/2019 - 03/2003)
2.	Fogel, Evan L: 7 articles (01/2019 - 03/2003)
3.	Lehman, Glen A: 7 articles (05/2011 - 03/2003)
4.	Freeman, Martin L: 5 articles (01/2019 - 01/2006)
5.	Kamisawa, Terumi: 5 articles (01/2010 - 07/2004)
6.	Romagnuolo, Joseph: 5 articles (11/2009 - 11/2006)
7.	Costamagna, Guido: 4 articles (03/2019 - 01/2002)
8.	Devière, J: 4 articles (10/2010 - 01/2001)
9.	Egawa, Naoto: 4 articles (01/2010 - 01/2005)
10.	Wilcox, C Mel: 3 articles (01/2019 - 08/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Pancreas Divisum:

1.	Secretin FDA Link 01/01/2020 - "Secretin administration improved subjective MRCP image quality, improved subjective visualization of the pancreatic duct, and provided greater sensitivity for anatomic variants such as pancreas divisum in a cohort of children with nondilated pancreatic ducts." 03/01/2000 - "The number of segments of the main pancreatic duct visualized improved from 85 (91%) to 93 (100%) of 93 in group 1 and from 164 (65%) to 245 (97%) of 252 (P < .001) in group 2. Visualization of side branches improved from 22 (71%) to 31 (100%) of 31 in group 1 and from three (4%) to 53 (63%) of 84 (P < .001) in group 2. Pancreas divisum was visualized in one additional patient in group 1 and in six additional patients in group 2. The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of exocrine reserve." 08/01/2014 - "This study aimed to perform a structured meta-analysis of all eligible studies to assess the overall diagnostic use of magnetic resonance cholangiopancreatography (MRCP) alone or with secretin enhancement (secretin-enhanced MRCP [S-MRCP]) in the detection of pancreas divisum. " 05/01/2003 - "This study confirmed the use and safety of synthetic porcine secretin in facilitating cannulation of the minor papilla in patients with pancreas divisum in whom cannulation was difficult. " 10/13/2016 - "Magnetic resonance cholangiopancreatography (MRCP), MRCP after secretin stimulation (S-MRCP) and endoscopic ultrasonography (EUS) are all selected to diagnose pancreas divisum. "
2.	Methylene Blue (Methylthioninium Chloride)FDA Link 01/01/2004 - "In patients with pancreatic divisum, the cannulation rate of the dorsal duct can be improved by methylene blue staining and/or stimulation of the pancreatic secretion. " 03/01/2003 - "Methylene blue spraying or injection appears to be a helpful technique for identification of the inconspicuous minor papilla orifice in patients with pancreas divisum." 03/01/2003 - "Use of methylene blue to identify the minor papilla or its orifice in patients with pancreas divisum." 12/01/2018 - "Use of combined methylene blue chromoendoscopy and intravenous secretin for endoscopic therapy in pancreas divisum." 03/01/2003 - "Two techniques with methylene blue were used to identify the minor papilla and its orifice more clearly in a series of patients: spraying methylene blue over duodenal mucosa in the region suspected to contain the minor papilla with/without secretin or cholecystokinin agonist administration, and injection of contrast medium containing methylene blue into the ventral pancreatic duct by means of the major papilla in cases of incomplete pancreas divisum. "
3.	phytobacteriomycin (PBM)IBA 01/01/2022 - "Although our findings were compatible with Eastern studies, type D PBM (associated with pancreas divisum) was more frequent in our study population." 04/01/2010 - "The present study was designed to reveal the incidence and clinical features of pancreas divisum in cases of PBM. " 08/02/2018 - "We encountered a patient with PBM and incomplete pancreatic divisum (PD). " 04/01/2010 - "Pancreas divisum exists in 1.4% of PBM. " 04/01/2010 - "Although PBM and pancreas divisum are congenital anomalies causing pancreatitides, distinct data about the incidence of pancreas divisum in pediatric PBM has not been reported to date. "
4.	Lipase (Acid Lipase)FDA Link 08/01/1997 - "This study describes a rapid increase of serum lipase activity during an episode of severe abdominal pain in a female patient with macrolipasaemia and pancreas divisum. " 06/01/2000 - "Pancreatitis was documented by elevated amylase or lipase levels, and endoscopic retrograde cholangiopancreatography was the method of diagnosis of pancreas divisum in all patients. "
5.	Hydrochloric Acid (Hydrogen Chloride)FDA Link 06/01/2010 - "Intraduodenal hydrochloric acid infusion for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a preliminary study."
6.	Amino Acids FDA Link 05/01/2003 - "In this study, a new synthetic porcine secretin with an identical amino acid composition was compared with saline solution for the facilitation of minor papilla cannulation in patients with pancreas divisum. "
7.	Saline SolutionIBA 05/01/2003 - "In this study, a new synthetic porcine secretin with an identical amino acid composition was compared with saline solution for the facilitation of minor papilla cannulation in patients with pancreas divisum. "
8.	Amylases FDA Link 05/01/2003 - "Serum amylases and lipases, WBC, and Ranson's score tended to be lower in patients with AGP and pancreas divisum, but the difference was not significant in comparison with control individuals. " 01/01/2002 - "The amylase level in liquid aspirated from the cyst was 37 869 IU/l, and the result of cytological examination of the liquid showed class II. A pancreatico(cysto)jejunostomy was performed, with the diagnosis being pancreas divisum associated with a retention cyst following obstruction of the minor papilla. " 04/01/1998 - "AIM:To inquire into the ERCP and CT features of pancreas divisum (PD) and its role in the etiology of chronic pancreatitis.METHODS:Fourteen patients with PD were analyzed in regard to the findings in ERCP and CT,the activities of serum amylase and the incidence of pancreatitis.Dorsal" 09/01/2005 - "Important observations include the following: (1) Strong association between cystic fibrosis transmembrane regulator dysfunction/mutations and 'recurrent acute pancreatitis', particularly in patients with pancreas divisum (2) Pancreas divisum may be incidental finding in recurrent acute pancreatitis (3) Smoking increases risk of chronic pancreatitis (4) Coxsackie B virus may increase severity of alcoholic chronic pancreatitis (5) CD4+ T cells and an immune reaction against amylase may play a role in pathogenesis of autoimmune pancreatitis (6) 2-(18F)-Fluro-2-deoxy-D-glucose positron emission tomography might be useful to detect pancreatic cancer in chronic pancreatitis patients at risk for developing pancreatic cancer, but contrast-enhanced Doppler ultrasound or endosonography may be as sensitive and better than contrast enhanced computed tomography (7) Superiority of surgery vs endotherapy for long term pain relief and weight gain in painful chronic pancreatitis (8) Early treatment of pain and malabsorption may improve life quality (9) Antifibrogenesis and fibrolytic agents as potential therapies. " 05/01/2003 - "Levels of serum amylases, lipases, C-reactive protein (CRP), and white blood cells (WBC) were compared in patients with AGP and pancreas divisum and in control individuals before sphincterotomy. "
9.	MucinsIBA 07/01/1991 - "The excretion of mucin through a patulous orifice of the enlarged ampulla of Vater was seen in six patients and of the enlarged minor papilla in the other patient with pancreas divisum. " 01/01/2004 - "The preoperative diagnosis was mucin-producing pancreatic tumor in the ventral pancreas of a patient with pancreas divisum. " 11/01/2000 - "A case of mucin-producing cystic tumor of the pancreas with pancreas divisum in a 65-year-old man is presented who was followed-up for 5 years prior to diagnosis of cancer and surgery. " 06/01/1996 - "The combination of a mucin-producing tumor and pancreas divisum is rare, and this is only the third reported case." 06/01/1996 - "We present the autopsy case of an 82-year-old Japanese woman with a mucin-producing adenoma accompanied by pancreas divisum and a hepatic hilar carcinoma. "
10.	EnzymesIBA 05/01/2005 - "Pancreas divisum, the most frequent congenital variant of pancreatic ductal configuration, might impair intraductal delivery of enzyme for islet isolation. " 05/01/2009 - "In the remaining 6 subjects (9.5%), the following alterations were found: pancreas divisum in 2, small intrapancreatic cyst in 2, anatomic variant of the Wirsung in 1, and mild dilatation of 3 secondary ducts in 1. In these 6 subjects, hyperenzymemia was highly variable from day to day, with frequent normalizations, as was also true for the 30 subjects with no MRCP alterations in whom diurnal enzyme determinations were made. " 04/15/2015 - "A patient diagnosed with Rubinstein-Taybi syndrome has recurrent abdominal pain of six months and elevated pancreatic enzymes, he underwent a magnetic resonance imaging where pancreas divisum is suspected. " 05/01/2004 - "However, pancreas divisum patients with well-defined bouts of pancreatitis are more likely to benefit from endoscopic minor papillotomy than those without symptom-free intervals between "attacks" and those with pain that is not associated with elevated pancreatic enzymes." 05/01/2004 - "Pancreas divisum has been associated with recurrent acute pancreatitis, chronic abdominal pain without elevated pancreatic enzymes, and chronic pancreatitis. "

Therapies and Procedures

1.	Sphincterotomy 01/01/1995 - "Endoscopic stenting and sphincterotomy of the minor papilla are feasible and may be effective in some patients with pancreas divisum but carries a significant complication rate. " 01/01/2012 - "Four RAP patients with pancreas divisum underwent endoscopic minor papilla sphincterotomy and improved. " 02/01/2023 - "Pancreas divisum was noted in three patients, all of whom underwent minor-papilla sphincterotomy. " 06/01/2021 - "We aimed to assess factors impacting the endoscopic minor papilla sphincterotomy (EMPS) success rate, clinical efficacy, and safety in a large cohort of patients with symptomatic pancreas divisum (PD). " 01/01/2009 - "One hundred twenty-eight consecutive patients with pancreas divisum who underwent ERCPs between April 2001 and April 2007, 64 of whom underwent an initial minor papilla sphincterotomy. "
2.	Therapeutics 01/01/2017 - "The efficacy of endoscopic therapy for pancreas divisum: a meta-analysis." 09/01/2017 - "Consequently, a randomized trial is needed to clarify if endoscopy or surgery is superior in the therapy of pancreas divisum." 09/01/2017 - "A Medline search was performed to identify all studies, investigating endoscopic or surgical therapy of Pancreas divisum. " 01/01/2017 - "The 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. " 07/01/2021 - "Clinical outcome of endoscopic therapy in patients with symptomatic pancreas divisum: a Dutch cohort study."
3.	Stents 01/01/2021 - "We describe a case of proximal migration of a pancreatic stent in a patient with pancreas divisum and perform a review of literature." 01/01/2021 - "Proximal migration of pancreatic stents in pancreas divisum is rare and challenging to manage. " 01/01/2021 - "Proximal Migration of Pancreatic Duct Stent in Pancreas Divisum: Challenges in Retrieval and Review of the Literature." 12/01/2018 - "In 10 patients, the FC-SEMS was inserted through the major papilla, whereas 5 patients (3 pancreas divisum, 2 dominant dorsal duct) received the stent through the minor papilla. " 09/01/2013 - "Five patients in group 1 were selected to receive a pancreatic stent (21%); in group 2 stenting was successful in 75 of 78 patients (success rate 96%) without pancreas divisum (n = 5). "
4.	Endoscopic Sphincterotomy 03/01/2007 - "An endoscopic sphincterotomy and temporary transpapillary pancreatic stenting were therefore suggested to be a beneficial treatment modality for patients with pancreas divisum." 03/01/2007 - "This study evaluated the results of an endoscopic sphincterotomy of the minor papilla and temporary transpapillary pancreatic stenting in patients with pancreas divisum. " 01/01/2014 - "Role of endoscopic sphincterotomy of the minor papilla in pancreas divisum." 07/01/2013 - "Pancreas divisum patients with focal obstruction of the minor papilla and resulting dilation of the dorsal pancreatic duct [a santorinicele (SC)] have been reported to improve with endoscopic sphincterotomy of the minor papilla (ESMP). " 03/01/2007 - "An endoscopic sphincterotomy of the minor papilla in the management of symptomatic pancreas divisum."
5.	Pancreatectomy 03/01/2006 - "In patients with pancreas divisum, dorsal pancreatectomy can be proposed for noninvasive IPMN involving only the dorsal pancreas to avoid drawbacks of total duodenopancreatic resection." 04/15/2015 - "[Distal pancreatectomy as surgical option in Pancreas divisum associated with Rubinstein-Taybi syndrome]." 04/01/2008 - "Overall, 6 pediatric patients (3 male, 3 female, ages 7-18 years) underwent a duodenum-preserving pancreatic head resection (3), a middle segmental pancreatic resection (2), or a distal pancreatectomy (1) for CP of different etiologies (idiopathic 2, posttraumatic 2, pancreas divisum 1, situs inversus 1). " 01/01/2005 - "Total dorsal pancreatectomy for intraductal papillary mucinous neoplasm in a patient with pancreas divisum." 11/01/1984 - "Whereas accessory papilla sphincteroplasty appears to be effective for recurrent pancreatitis associated with true pancreas divisum, false pancreas divisum requires distal pancreatectomy or pancreaticojejunostomy to overcome the irreversible obstruction of the main pancreatic duct."