Tadao Tsuji¹, G Sun¹, A Sugiyama¹, Y Amano¹, S Mano¹, T Shinobi¹, H Tanaka¹, M Kubochi¹, Ohishi¹,Y Moriya¹,H Kaihara¹,S Yamamoto¹, M Ono¹, T Masuda¹, H Shinozaki², H Kaneda², H Katsura²,T Mizutani², K Miura², M Katoh², K Yamafuji³, K Takeshima³, N Okamoto³, S Nyuhzuki⁴
We have experienced 62 cases of incomplete pancreatic divisum (IPD) over the past 9 years. This is 4.1% (62/1524) of naïve ERP cases during this period. Many classifications were reported in the literature. We classified them by modified “Hirooka’s classification” into stenotic fusion type1,2 (sf1, sf2), ansa pancreatica type and branch fusion type1,2,3 (bf1,2,3). 16 cases could be diagnosed by MRCP alone. 47 symptomatic cases were treated by ESWL and/or endoscopy, while 14 asymptomatic cases had no therapy, and 1 asymptomatic case was operated without medical treatment-tail pseudocyst resection. 80%(37/46) of symptomatic patients had a history of alcohol intake, while 69% (11/16) of asymptomatic case had no alcohol intake history.
Endoscopic treatments via major papilla were performed in 15 cases with a success rate of 100%, while treatments via minor papilla were performed in 30 cases with a success rate of 93% (28/30) without severe complications. In 4 difficult cases, we performed our new endoscopic procedures; rendezvous precut method and reverse balloon dilation method. In 43 calcified cases, ESWL and/or endoscopy were performed repeatedly more than 19 non-calcified cases by stone relapse.
After endoscopic treatments, the prognosis was good in 43, poor in 3 and 1 had an operation by pain relapse. EPS is now placed in 36 cases (major13 , minor23 ) to prevent pain relapse and papilla occlusion.
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