A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum.

BACKGROUND AND STUDY AIMS The rates for endoscopic detection of pancreas divisum at routine endoscopic retrograde cholangiopancreatography (ERCP) vary worldwide, and the sample sizes in the reported studies on endoscopy and surgery for pancreas divisum are very small and variable. The aim of this study was to systematically analyze the pooled data and determine endoscopic detection rates for pancreas divisum and pain relief rates in patients with pancreas divisum after endotherapy or surgery. MATERIALS AND METHODS A search for published data was performed by using the Medline database (1950 to 1st May 2008) with "pancreas divisum" as the keyword. Publications, mainly on endoscopic detection rate, endotherapy, or surgery for pancreas divisum, were deemed relevant, and were further fully reviewed and analyzed. RESULTS A total of 615 abstracts were retrieved from Medline; 17 articles on endoscopic detection rate, 15 articles on endotherapy, and 13 articles on surgery were included in the review and analysis. The overall endoscopic detection rate for pancreas divisum was 2.9% (899/31,413), with the rate being significantly higher in the United States (5.8%) and Europe (6.0%) than in Asia (1.5%) (both P < 0.001). The pooled overall response rates (i. e. complete and partial pain relief rates after treatment) to endotherapy (69.4%, 361/520) and surgery (74.9%, 203/271) were similar (P = 0.106). In addition, there were significant differences in the combined response rates (for endotherapy and for surgery) between patients with pancreas divisum of acute recurrent pancreatitis (ARP)-type (81.2 %) compared with chronic pancreatitis-type (68.8%), and between ARP-type and pain-type (53.1%) (both P < 0.05). CONCLUSIONS The endoscopic detection rate for pancreas divisum is much higher in western countries than in Asian countries. The pooled response rates of patients with pancreas divisum to endotherapy and surgery are similar in the reported series. Patients with ARP-type pancreas divisum respond better to endotherapy or surgery than those with chronic pancreatitis-type and pain-type.