CT/MRCP negative for pancreas divisum: Is it always reliable?. A retrospective analysis

Aims To see the prevalence of pancreas divisum in CT/MRCP negative for divisum. Minor papilla cannulation attempt in such cases increases the technical success rate.

Methods A retrospective analysis of pancreatic ERCP performed for symptomatic chronic pancreatitis from 2021 till date at a tertiary care center in India. All the patient had either CT or MRCP as an imaging modality prior to ERCP. Major papilla cannulation was tried first in every patient as a standard technique. The patients in whom there was difficulty in deep cannulation even after engaged sphincterotome, pancreas divisum was suspected and minor papilla cannulation was then attempted.

Results Total no. of ERPs- 143 Major pancreatic duct cannulation- 110 (76.92%) Minor pancreatic duct cannulation (pancreas divisum) due to failed MPD cannulation- 15 (13.63%) Failed cannulation- 18 (16.36%) Out of failed cases- 03 had disconnected pancreatic duct, 08 had extreme edema and deformity and 07 had large stones burden.

Conclusions CT/MRCP doesn’t always pick up pancreas divisum. In such cases when glide wire didn’t go deep in MPD despite good engaged sphincterotome, a suspicion of divisum should be kept in mind. Minor papilla cannulation and further endotherapy increases the success rate and better outcome for patients in such cases. [1]

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Lu WF.. ERCP and CT diagnosis of pancreas divisum and its relation to etiology of chronic pancreatitis. World J Gastroenterol 1998; 4 (02) 150-152 PMID: 11819261; PMCID: PMC4688639.

Publication History

Article published online:
15 April 2024