Effectiveness of endoscopic drainage for pancreas divisum: endoscopic and surgical results in 31 patients.

Thirty-one patients with symptomatic pancreatitis and pancreas divisum were treated prospectively by inserting an endoprosthesis into the dorsal pancreatic duct for drainage. Pain was a feature characteristic of all 31 patients; of these 92% had an improvement in their subjective complaints of pain after sphincterotomy and insertion of a prosthesis in the minor papilla. During a two-year follow-up period, 84% (26/31) of the group showed improvement in all the signs and symptoms associated with their pancreatitis, and this improvement was sustained in all patients for at least several months. A group of twenty-six patients subsequently underwent pancreatic surgery for recurrent symptoms. Those patients who had improved with endoscopic drainage did significantly better following surgical drainage than those who had shown little or no improvement with an endoprosthesis. On the basis of the above preliminary results, we recommend preoperative insertion of an endoprosthesis into the dorsal duct as a therapeutic predictor of eventual surgical outcome.