Objective To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis and treatment of pancreas divisum(PD) associated with recurrent acute pancreatitis(RAP) in children and teenagers. Methods Data of patients with symptomatic PD associated with RAP under 18 years old who were diagnosed and treated with ERCP from January 2011 to January 2015 were retrospectively analyzed. Patients with complete pancreas divisum underwent endoscopic minor sphincterotomy combined with dorsal duct stenting ( ESCS ) , and those with incomplete pancreas divisum underwent bi?papilla endoscopic sphincterotomy combined with dorsal duct stenting ( Bi?ESCS ) . ERCP?related data, complications were recorded. Long?term follow?up was conducted for procedure related complications. Results Nine patients with symptomatic PD associated with RAP were firstly diagnosed. A total of 18 ERCP procedures were performed in these patients, with success rate of 100. 0% ( 18/18) in the minor papilla cannulation, and mild ERCP?related complication rate of 11. 1% ( 2/18) . One was acute mild pancreatitis and the other was hyperamylasemia. During follow?up from 3 to 60 months, all patients had pain relief, among whom 7 were asymptomatic, with no onset of acute pancreatitis. Dorsal ducts of all patients were not obviously dilated in MRCP or CT scan. All patients gained weight and presented normal physical and intelligence development. Conclusion Symptomatic PD associated with RAP can be completely diagnosed with ERCP . ESCS and Bi?ESCS are safe and effective endoscopic treatment techniques for pediatric cases.

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment of pancreas divisum (PD) combined with chronic pancreatitis (CP) in children.Methods:Data of patients under 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2010 to January 2020 were retrospectively analyzed. The general information, endoscopic procedures and follow-up of the children were recored. The number of acute pancreatitis attacks, visual analogue scale (VAS) scores of the abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 19 children diagnosed as having PD with CP underwent 82 ERCP procedures with the mean number of 4.31 (1-9). The mean number of pancreatic stent replacement was 3.21 (0-8). The success rate of minor papilla cannulation was 97.6% (80/82) with the pain relief rate of 89.5% (17/19) after the first ERCP. ERCP-related complication rate was 4.9% (4/82)without transference to surgery. The mean follow-up time was 55.8 months (9-114 months). The median number of acute pancreatitis attacks decreased from 3.0 to 0 compared with that before the procedure ( Z=-3.839, P<0.001) and the median VAS score decreased from 6 to 1 ( Z=-3.748, P<0.001), both of which had significant difference. However, the median diameters of main pancreatic duct were both 0.35 cm before and after procedure with no significant difference ( Z=-0.699, P=0.484). Conclusion:ERCP is safe and effective to diagnose and treat pediatric patients with PD with CP.

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreas divisum(PD)with chronic pancreatitis (CP) in adults.Methods:Data of patients older than 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2008 to January 2020 were retrospectively analyzed, i. e.the general information, ERCP procedures and follow-up data of the patients. The number of acute pancreatitis attacks, visual analogue scale (VAS) of abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 61 patients diagnosed as having PD with CP underwent 301 ERCP procedures with the median number of 4(3.0-6.5). The median number of pancreatic stent replacement was 3 (2-6). The success rate of the first minor papilla cannulation was 90.2% (55/61), and the total success rate of minor papilla cannulation was 98.0% (295/301). The efficacy rate of the first ERCP was 82.0% (50/61). ERCP-related complication rate was 2.7% (8/301). The median follow-up time was 54 months (31.0-97.5 months). The median number of acute pancreatitis attacks decreased from 2.40 to 0 ( Z=-6.726, P<0.001) compared with that before ERCP. The median VAS decreased from 7 to 2 ( Z=-6.621, P<0.001). The median pancreatic duct diameter decreased from 5.0 mm to 4.0 mm ( Z=-2.330, P=0.020). However, the mean weight increased from 56.04±10.75 kg to 58.62±10.79 kg ( t=-5.285, P<0.001)one year after the procedure. Conclusion:ERCP is safe and effective in the diagnosis and treatment of PD with CP in adults.