ACCESSORY DUCT SPHINCTEROPLASTY IS PREFERRED FOR LONG-TERM PREVENTIONOF RECURRENT ACUTE-PANCREATITIS IN PATIENTS WITH PANCREAS DIVISUM

BACKGROUND: The putative relationship between pancreas divisum and cli nical pancreatitis continues to be controversial, Indications for surg ical or endoscopic manipulations of the accessory duct ampulla are unc lear, and the relative merits of surgical sphincteroplasty, endoscopic sphincterotomy, and accessory duct stenting have not been established . STUDY DESIGN: Thirty-seven patients with documented pancreas divisum and acute pancreatitis identified by readily available clinical crite ria were entered into a prospective five-year study of the value of su rgical sphincteroplasty in preventing recurrent episodes of acute panc reatitis and eliminating ''pancreatic pain.'' A broader therapeutic pe rspective was developed by means of an extensive analysis of existing surgical and endoscopic literature. RESULTS: Surgical accessory duct s phincteroplasty was successful in 83.8 percent of our patients in the long-term prevention of recurrent acute pancreatitis, but was signific antly less successful in improving ''pancreatic pain'' (p<0.001). Coll ected surgical results are superior to reported outcomes from endoscop ic accessory papillotomy with regard to relief of ''pancreatic pain,'' rate of restenosis, and generation of procedure-specific complication s. Prolonged stenting of the accessory duct cannot be recommended. CON CLUSIONS: Patients with pancreas divisum and recurrent acute pancreati tis who will benefit from therapy can be identified by clinical means. Surgical sphincteroplasty provides superior long-term results compare d to endoscopic sphincterotomy.