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Stuart Sherman - One of the best experts on this subject based on the ideXlab platform.
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identification and management of Pancreas Divisum
Expert Review of Gastroenterology & Hepatology, 2019Co-Authors: Aditya Gutta, Evan L Fogel, Stuart ShermanAbstract:Pancreas Divisum, the most common congenital malformation of the Pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of Pancreas Divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify Pancreas Divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.
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accuracy of magnetic resonance cholangiopancreatography in the diagnosis of Pancreas Divisum
Digestive Diseases and Sciences, 2012Co-Authors: Patrick Mosler, Fatih Akisik, Kumaresan Sandrasegaran, Evan L Fogel, James L Watkins, Waleed M Alazmi, Stuart Sherman, Glen A Lehman, Thomas F ImperialeAbstract:Patients with Pancreas Divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing Pancreas Divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing Pancreas Divisum. To evaluate the diagnostic accuracy of MRCP in detecting Pancreas Divisum at our institution. We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. ERP identified Pancreas Divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 Pancreas Divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3–25.3]). MRCP without secretin is non-diagnostic for Pancreas Divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting Pancreas Divisum. However, the sensitivity of S-MRCP for the diagnosis of Pancreas Divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.
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Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in the Diagnosis of Pancreas Divisum (PD)
Gastrointestinal Endoscopy, 2005Co-Authors: Patrick Mosler, Kumaresan Sandrasegaran, Evan L Fogel, James L Watkins, Stuart Sherman, Lee Mchenry, M.f. Akisik, Waleed Alzami, Glen A LehmanAbstract:Background Patients with Pancreas Divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing Pancreas Divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing Pancreas Divisum.
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diagnosis and therapy of Pancreas Divisum
Gastrointestinal Endoscopy Clinics of North America, 1998Co-Authors: Glen A Lehman, Stuart ShermanAbstract:Abstract Pancreas Divisum patients make up a small but problematic portion of ERCP cases. Minor papilla cannulation techniques have been improved. Recurrent pancreatitis patients generally benefit from minor papilla therapy. Methods to select patients who are likely to respond to invasive therapy need refinement. Clinicians and endoscopists are strongly encouraged to be cautious and conservative with this patient group until stronger data indicate optimal management schemes.
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Pancreas Divisum diagnosis clinical significance and management alternatives
Gastrointestinal Endoscopy Clinics of North America, 1995Co-Authors: Glen A Lehman, Stuart ShermanAbstract:Pancreas Divisum cases continue to challenge the endoscopist and clinician. Relative minor papilla narrowing in select Pancreas Divisum patients appears to cause pain or pancreatitis. Minor papilla cannulation techniques continue to improve. Endoscopic therapeutic techniques of stenting and sphincterotomy yield therapeutic benefit similar to open surgical methods, although follow-up intervals are shorter for endoscopy. Recurrent pancreatitis patients are the best candidates for treatment.
Glen A Lehman - One of the best experts on this subject based on the ideXlab platform.
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accuracy of magnetic resonance cholangiopancreatography in the diagnosis of Pancreas Divisum
Digestive Diseases and Sciences, 2012Co-Authors: Patrick Mosler, Fatih Akisik, Kumaresan Sandrasegaran, Evan L Fogel, James L Watkins, Waleed M Alazmi, Stuart Sherman, Glen A Lehman, Thomas F ImperialeAbstract:Patients with Pancreas Divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing Pancreas Divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing Pancreas Divisum. To evaluate the diagnostic accuracy of MRCP in detecting Pancreas Divisum at our institution. We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. ERP identified Pancreas Divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 Pancreas Divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3–25.3]). MRCP without secretin is non-diagnostic for Pancreas Divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting Pancreas Divisum. However, the sensitivity of S-MRCP for the diagnosis of Pancreas Divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.
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Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in the Diagnosis of Pancreas Divisum (PD)
Gastrointestinal Endoscopy, 2005Co-Authors: Patrick Mosler, Kumaresan Sandrasegaran, Evan L Fogel, James L Watkins, Stuart Sherman, Lee Mchenry, M.f. Akisik, Waleed Alzami, Glen A LehmanAbstract:Background Patients with Pancreas Divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing Pancreas Divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing Pancreas Divisum.
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diagnosis and therapy of Pancreas Divisum
Gastrointestinal Endoscopy Clinics of North America, 1998Co-Authors: Glen A Lehman, Stuart ShermanAbstract:Abstract Pancreas Divisum patients make up a small but problematic portion of ERCP cases. Minor papilla cannulation techniques have been improved. Recurrent pancreatitis patients generally benefit from minor papilla therapy. Methods to select patients who are likely to respond to invasive therapy need refinement. Clinicians and endoscopists are strongly encouraged to be cautious and conservative with this patient group until stronger data indicate optimal management schemes.
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Pancreas Divisum diagnosis clinical significance and management alternatives
Gastrointestinal Endoscopy Clinics of North America, 1995Co-Authors: Glen A Lehman, Stuart ShermanAbstract:Pancreas Divisum cases continue to challenge the endoscopist and clinician. Relative minor papilla narrowing in select Pancreas Divisum patients appears to cause pain or pancreatitis. Minor papilla cannulation techniques continue to improve. Endoscopic therapeutic techniques of stenting and sphincterotomy yield therapeutic benefit similar to open surgical methods, although follow-up intervals are shorter for endoscopy. Recurrent pancreatitis patients are the best candidates for treatment.
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Pancreas Divisum results of minor papilla sphincterotomy
Gastrointestinal Endoscopy, 1993Co-Authors: Glen A Lehman, Stuart Sherman, Rod Nisi, Robert H HawesAbstract:A subpopulation of Pancreas Divisum patients may have pancreatic pain or pancreatitis as a result of a stenotic minor papilla. This study was undertaken to evaluate the efficacy of minor papilla sphincterotomy in 52 Pancreas Divisum patients who had disabling chronic pancreatic pain (n=24), acute recurrent pancreatitis (n=17), or chronic pancreatitis (n=11). Patients were symptomatic for a mean time of 5.1 years and had failed to respond to conservative therapy. Minor papilla sphincterotomy was performed with a needle knife over a previously placed minor papilla/dorsal pancreatic duct stent. Clinical improvement was assessed by comparison of symptoms (using a 0 to 10 scale) and number of hospital days per month required for pain or pancreatitis for an equal period of time before and after therapy. The average duration of follow-up was 1.7 years. As compared with the chronic pain and chronic pancreatitis groups, the acute recurrent pancreatitis group had a significant reduction in the mean symptom score and number of hospital days per month. Patients with acute recurrent pancreatitis benefited from minor papilla sphincterotomy more frequently than those with chronic pancreatitis (76.5% versus 27.3%, p =0.01) or chronic pain (76.5% versus 26.1%, p =0.002). Complications followed 15% of the procedures; they consisted primarily of mild pancreatitis, although one additional patient died of a pancreatic abscess after a failed cannulation. Fifty percent of patients evaluated at the time of stent removal had stent-induced dorsal duct changes. The results of this study support the performance of minor papilla therapy in Pancreas Divisum patients who have acute recurrent pancreatitis. Pending methods to better predict outcome, this therapy should be avoided in patients with chronic pancreatitis or chronic pancreatic pain.
Terumi Kamisawa - One of the best experts on this subject based on the ideXlab platform.
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pancreatic diseases associated with Pancreas Divisum
Digestive Surgery, 2010Co-Authors: Kensuke Takuma, Terumi Kamisawa, Naoto Egawa, Taku Tabata, Yoshinori IgarashiAbstract:Aim: To clarify the features of acute or chronic pancreatitis and pancreatic tumors associated with complete and incomplete Pancreas Divisum. Methods: Clinical fe
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clinical implications of incomplete Pancreas Divisum
Journal of the Pancreas, 2006Co-Authors: Terumi Kamisawa, Yuyang Tu, Naoto Egawa, Kouji Tsuruta, Aatsutake OkamotoAbstract:Context Incomplete Pancreas Divisum is a pancreatic anomaly that results in an inadequate communication between the ventral and dorsal pancreatic ducts. Although the relationship between complete Pancreas Divisum and pancreatitis has been contentious, clinical implications of incomplete Pancreas Divisum have not been noted. Objective This study was done to investigate the clinical significance of incomplete Pancreas Divisum. Patients and methods We studied the anatomy of the pancreatic duct system in 3,220 cases using endoscopic retrograde pancreatography; 44 cases had complete Pancreas Divisum, and 41 had incomplete Pancreas Divisum. Main outcome measure The prevalence of chronic and acute pancreatitis associated with complete or incomplete Pancreas Divisum was compared with that of cases with neither complete nor incomplete PD (controls). Results All of the patients with complete or incomplete Pancreas Divisum who abused alcohol had chronic or acute pancreatitis. The prevalence of chronic pancreatitis in patients with complete or incomplete Pancreas Divisum was significantly higher than in controls (P<0.001 and P=0.001, respectively), but acute pancreatitis occurred more frequently only in patients with complete Pancreas Divisum (P=0.010). When we considered pancreatic-type pain as a pancreatitis-like disease, complete and incomplete Pancreas Divisum were suspected as the cause of pancreatitis-like disease in 39% (15/38: chronic dorsal pancreatitis, n=5; acute pancreatitis, n=7; pancreatic-type pain, n=3) and 30% (10/33: chronic dorsal pancreatitis, n=2; acute relapsing pancreatitis, n=1; pancreatic-type pain, n=7) of patients who did not abuse alcohol, respectively. Conclusions Although the precise pathophysiology may differ, patients with complete Pancreas Divisum and patients with incomplete Pancreas Divisum may have similar presentations and a similar prevalence. The clinical implications of incomplete Pancreas Divisum may be similar to those of complete Pancreas Divisum.
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Clinical implications of incomplete Pancreas Divisum.
Journal of the Pancreas, 2006Co-Authors: Terumi Kamisawa, Yuyang Tu, Naoto Egawa, Kouji Tsuruta, Aatsutake OkamotoAbstract:Context Incomplete Pancreas Divisum is a pancreatic anomaly that results in an inadequate communication between the ventral and dorsal pancreatic ducts. Although the relationship between complete Pancreas Divisum and pancreatitis has been contentious, clinical implications of incomplete Pancreas Divisum have not been noted. Objective This study was done to investigate the clinical significance of incomplete Pancreas Divisum. Patients and methods We studied the anatomy of the pancreatic duct system in 3,220 cases using endoscopic retrograde pancreatography; 44 cases had complete Pancreas Divisum, and 41 had incomplete Pancreas Divisum. Main outcome measure The prevalence of chronic and acute pancreatitis associated with complete or incomplete Pancreas Divisum was compared with that of cases with neither complete nor incomplete PD (controls). Results All of the patients with complete or incomplete Pancreas Divisum who abused alcohol had chronic or acute pancreatitis. The prevalence of chronic pancreatitis in patients with complete or incomplete Pancreas Divisum was significantly higher than in controls (P
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pancreatic tumor associated with Pancreas Divisum
Journal of Gastroenterology and Hepatology, 2005Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Masami Yoshiike, Atsutake Okamoto, Nobuaki FunataAbstract:Abstract Background: Although there has been considerable controversy regarding Pancreas Divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. Methods: A retrospective investigation was undertaken of pancreatic tumors associated with Pancreas Divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal papillary mucinous tumor of the Pancreas and 32 cases of Pancreas Divisum. Results: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal papillary mucinous tumor (n = 1). All tumors developed from the dorsal Pancreas of Pancreas Divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous Pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with Pancreas Divisum preceded carcinoma. Conclusions: Pancreatic tumors were detected in 12.5% of cases of Pancreas Divisum. In Pancreas Divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the minor duodenal papilla might be a factor promoting oncogenesis. © 2005 Blackwell Publishing Asia Pty Ltd
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Annular Pancreas associated with carcinoma in the dorsal part of Pancreas Divisum
International Journal of Pancreatology, 1995Co-Authors: Terumi Kamisawa, Ikuo Tabata, Tomoaki Isawa, Jun-ichi Ishiwata, Masashi Fukayama, Morio KoikeAbstract:A carcinoma in the dorsal part of the Pancreas Divisum with an annular Pancreas in the anterior part is reported. A 79-yr-old female was admitted in our hospital complaining of epigastralgia. Computed tomography (CT) and ultrasound (US) showed an irregular mass in the pancreatic body. A pancreatogram obtained through the major duodenal papilla demonstrated only the ventral pancreatic duct that encircled the duodenum. Contrast medium injected from the minor duodenal papilla showed Santorini’s duct obstruction at the neck portion of the Pancreas without communication with the ventral pancreatic duct. The patient died with liver metastases. Autopsy confirmed annular Pancreas and a 6-cm tumor in the pancreatic body extending to the pancreatic head and Pancreas Divisum. Pancreatic carcinoma; histologically a moderately differentiated adenocarcinoma; originated from the dorsal part of Pancreas Divisum. To our knowledge this is the first report of pancreatic carcinoma associated with annular Pancreas coexistent with Pancreas Divisum.
Robert H Hawes - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of Pancreas Divisum by endoscopic ultrasonography
Endoscopy, 1999Co-Authors: Manoop S Bhutani, Brenda J Hoffman, Robert H HawesAbstract:Background and Study Aims: During pancreatobiliary imaging by endoscopic ultrasound (EUS) at the authors' institution, it is customary to attempt to obtain the stack sign, where the bile duct and the pancreatic duct can be seen to run in parallel through the pancreatic head. We suspected that such a view may not be attainable in patients with Pancreas Divisum because of the short ventral pancreatic duct. The aim of the study was to investigate whether the presence of Pancreas Divisum could be suspected on the basis of EUS findings. Patients and Methods: The stack sign is obtained by positioning the echo endoscope in the long scope position with the transducer in the duodenal bulb. The balloon is then inflated and advanced snugly into the apex of the bulb. From this position, the bile duct (closest to the transducer) and the pancreatic duct can be seen to run in parallel through the pancreatic head. We attempted to obtain a stack sign during EUS examinations of six patients with Pancreas Divisum. EUS was done in these patients to look for evidence of chronic pancreatitis and the Pancreas Divisum was confirmed by endoscopic retrograde pancreatography. An attempt to obtain the stack sign was also made in 30 patients who had EUS for pancreatobiliary indications but did not have Pancreas Divisum. Results: In only two out of six patients with Pancreas Divisum (33 %) were we able to obtain a stack sign. This was significantly different from the rate of observation of a stack sign in 83.3 % (25/30) of patients who did not have Pancreas Divisum (P=0.04). Of the two patients with Pancreas Divisum in whom a stack sign was seen, the ventral duct was markedly dilated (6.6 mm) in one, and the other patient had an unusually large ventral Pancreas. Conclusions: The absence of a stack sign during pancreatobiliary imaging by EUS may suggest the diagnosis of Pancreas Divisum.
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Pancreas Divisum results of minor papilla sphincterotomy
Gastrointestinal Endoscopy, 1993Co-Authors: Glen A Lehman, Stuart Sherman, Rod Nisi, Robert H HawesAbstract:A subpopulation of Pancreas Divisum patients may have pancreatic pain or pancreatitis as a result of a stenotic minor papilla. This study was undertaken to evaluate the efficacy of minor papilla sphincterotomy in 52 Pancreas Divisum patients who had disabling chronic pancreatic pain (n=24), acute recurrent pancreatitis (n=17), or chronic pancreatitis (n=11). Patients were symptomatic for a mean time of 5.1 years and had failed to respond to conservative therapy. Minor papilla sphincterotomy was performed with a needle knife over a previously placed minor papilla/dorsal pancreatic duct stent. Clinical improvement was assessed by comparison of symptoms (using a 0 to 10 scale) and number of hospital days per month required for pain or pancreatitis for an equal period of time before and after therapy. The average duration of follow-up was 1.7 years. As compared with the chronic pain and chronic pancreatitis groups, the acute recurrent pancreatitis group had a significant reduction in the mean symptom score and number of hospital days per month. Patients with acute recurrent pancreatitis benefited from minor papilla sphincterotomy more frequently than those with chronic pancreatitis (76.5% versus 27.3%, p =0.01) or chronic pain (76.5% versus 26.1%, p =0.002). Complications followed 15% of the procedures; they consisted primarily of mild pancreatitis, although one additional patient died of a pancreatic abscess after a failed cannulation. Fifty percent of patients evaluated at the time of stent removal had stent-induced dorsal duct changes. The results of this study support the performance of minor papilla therapy in Pancreas Divisum patients who have acute recurrent pancreatitis. Pending methods to better predict outcome, this therapy should be avoided in patients with chronic pancreatitis or chronic pancreatic pain.
Mehmet Yildirim - One of the best experts on this subject based on the ideXlab platform.
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Pancreas Divisum a risk factor for pancreaticobiliary tumors an analysis of 1628 mr cholangiography examinations
Diagnostic and interventional imaging, 2017Co-Authors: Zehra Hilal Adibelli, Mustafa Adatepe, L Isayeva, Ozgur Sipahi Esen, Mehmet YildirimAbstract:Abstract Purpose This retrospective study was conducted to evaluate the relationships between Pancreas Divisum, biliary duct anatomical variations and pancreaticobiliary tumors using magnetic resonance cholangiopancreatography (MRCP). Materials and method The MRCP examinations of 1628 patients were retrospectively reviewed for the presence of Pancreas Divisum, biliary duct anatomical variations and pancreaticobiliary tumors. Of these, 90 patients (31 men, 59 women) with a mean age of 62.6 years ± 15.8 (SD) (range: 22–101 years) had Pancreas Divisum. MRCP images were analyzed by two independent readers with discordances resolved by consensus opinion. Results A total of 1538/1628 patients (94.5%) had a dominant duct of Wirsung; of them 54/1538 patients (3.5%) had pancreaticobiliary tumors. A total of 90/1628 patients had Pancreas Divisum; of them, 7/90 patients (7.8%) had pancreaticobiliary tumors, including intrapancreatic mucinous neoplasm ( n = 3), ampullary carcinoma ( n = 2), Pancreas carcinoma and gallbladder carcinoma ( n = 1 each). Pancreaticobiliary tumors were more frequent in patients with Pancreas Divisum than in those with a dominant duct of Wirsung ( P = 0.0383). Conclusions The results of our study suggest that patients with Pancreas Divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.
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Pancreas Divisum: A risk factor for pancreaticobiliary tumors – an analysis of 1628 MR cholangiography examinations
Diagnostic and interventional imaging, 2016Co-Authors: Zehra Hilal Adibelli, Mustafa Adatepe, L Isayeva, Ozgur Sipahi Esen, Mehmet YildirimAbstract:Abstract Purpose This retrospective study was conducted to evaluate the relationships between Pancreas Divisum, biliary duct anatomical variations and pancreaticobiliary tumors using magnetic resonance cholangiopancreatography (MRCP). Materials and method The MRCP examinations of 1628 patients were retrospectively reviewed for the presence of Pancreas Divisum, biliary duct anatomical variations and pancreaticobiliary tumors. Of these, 90 patients (31 men, 59 women) with a mean age of 62.6 years ± 15.8 (SD) (range: 22–101 years) had Pancreas Divisum. MRCP images were analyzed by two independent readers with discordances resolved by consensus opinion. Results A total of 1538/1628 patients (94.5%) had a dominant duct of Wirsung; of them 54/1538 patients (3.5%) had pancreaticobiliary tumors. A total of 90/1628 patients had Pancreas Divisum; of them, 7/90 patients (7.8%) had pancreaticobiliary tumors, including intrapancreatic mucinous neoplasm ( n = 3), ampullary carcinoma ( n = 2), Pancreas carcinoma and gallbladder carcinoma ( n = 1 each). Pancreaticobiliary tumors were more frequent in patients with Pancreas Divisum than in those with a dominant duct of Wirsung ( P = 0.0383). Conclusions The results of our study suggest that patients with Pancreas Divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.
