Incomplete pancreas divisum: Is it merely a normal anatomic variant without clinical implications?

Background and Study Aims: Incomplete pancreas divisum (PD) has been genera lly regarded as merely a normal anatomic variant, without clinical implicat ions. This study compares the prevalence, symptom occurrence rate, clinical presentation, and outcomes of endoscopic treatment in patients with incomp lete PD and those with complete PD. Patients and Methods: The study population consisted of 56 patients (27 wit h complete PD and 29 with incomplete PD), identified from 4473 newly perfor med endoscopic retrograde cholangiopancreatography examinations. Endoscopic treatment (minor papilla sphincterotomy with stents or nasopancreatic drai nage tube insertion) was attempted in 25 symptomatic patients with PD, whic h was suspected to be causing the associated pancreatic diseases: acute rec urrent pancreatitis (ARP) (n = 13; five patients with complete PD and eight with incomplete PD); chronic pancreatitis (CP) (n = 10: five patients. wit h complete PD and five with incomplete PD); and pancreatic-type pain (PP) ( n = 2; one patient with complete PD and one with incomplete PD). The mean f ollow-up period was 17 months (range 9-49 months). Results: In 12 of the 27 patients with complete PD - six with ARP, five wit h CP, and one with PP - it was suspected that PD was the cause of pancreati c disease. Ten of the 11 symptomatic patients with complete PD underwent su ccessful endoscopic treatment (five with endoscopic minor papilla sphincter otomy and stenting and five with endoscopic minor papilla sphincterotomy an d endoscopic nasopancreatic drainage), and seven of these ten patients bene fited from the endoscopic treatment. In 14 of the 29 patients with incomple te PD eight with ARP, five with CP, and one with PP - it was suspected that pancreas divisum was the cause of pancreatic disease. Thirteen of the 14 s ymptomatic patients with incomplete PD underwent successful endoscopic trea tments (six with endoscopic minor papilla sphincterotomy and stenting, and seven with endoscopic minor papilla sphincterotomy and endoscopic nasopancr eatic drainage), and eight of these 13 patients experienced clinical improv ement. Conclusions: The prevalence rate, symptom occurrence rate, clinical present ation, and outcomes of endoscopic treatment were similar in patients with c omplete PD and incomplete PD. Incomplete PD may therefore have similar clin ical implications to those of complete PD.