70 Cases of Incomplete Pancreatic Divisum (IPD) – the Usefulness of MRCP Diagnosis and the Safety of Endoscopic Treatments via Duodenal Major and Minor Papilla

Abstract

Incomplete Pancreatic Divisum (IPD) is a rare congenital disease caused by maljunction between the ventral duct and the dorsal duct in the 7th week in embryonic stage. In our hospital over the past 10 years, 70 cases of IPD were diagnosed. This is 3.7% (70/1915) of naïve ERP cases during this period (2014.9.～2024.3.). Many classifications were proposed in the literature. We classified them by modified “Hirooka’s classification” into stenotic fusion typeⅠ,Ⅱ(sfⅠ７cases, sfⅡ1 case), ansa pancreatica type (0 case) and branch fusion typeⅠ,Ⅱ,Ⅲ(bfⅠ17 cases , bfⅡ0 case, bfⅢ 44 cases). MRCP was performed in 57 cases, and 20 cases (20/57=35%) were diagnosed by MRCP alone. Finally 49 cases could be correctly diagnosed by MRCP (49/57=86%). Symptomatic cases were treated by endoscopy -13 cases,ESWL -1 case, and ESWL + endoscopy -39 cases. Asymptomatic 14 cases had no therapy. About the Endoscopic treatment, via major papilla were performed in 19 cases with a technical success rate of 100%, while via minor papilla were performed in 34 cases with a technical success rate of 90% (28/34) without severe complications. In difficult cases, we performed our new endoscopic procedures; rendezvous precut method and reverse balloon dilation method in 8 cases. 81％(43/53) of symptomatic patients had a history of alcohol intake, while 71% (12/17) of asymptomatic case had no alcohol intake. So alcohol intake may make IPD symptomatic . After endoscopic treatments, the prognosis was good in 48, poor in 4 and 1 had an operation by pain relapse. In 50 calcified cases, ESWL and/or endoscopy were performed more repeatedly than 20 non-calcified cases .EPS is still placed in 39 cases (major14 , minor 25 ) to maintain the pancreas juice flow and to prevent the papilla occlusion.