The efficacy of endoscopic therapy for pancreas divisum: a meta-analysis

Published on Aug 23, 2017in Annals of Gastroenterology
· DOI :10.20524/AOG.2017.0159
Lamprinos Michailidis2
Estimated H-index: 2
(UK: University of Kentucky),
Bilal Aslam2
Estimated H-index: 2
(UK: University of Kentucky)
+ 1 AuthorsHoussam E. Mardini10
Estimated H-index: 10
(UK: University of Kentucky)
Sources
Abstract
Background The purpose of this study was to perform a meta-analysis assessing the efficacy and predictors of success of endoscopic therapy in the management of patients with pancreas divisum. Methods An electronic database search (PubMed and ScienceDirect) was performed for relevant studies. Studies were selected based on predefined criteria and data were extracted on patient population, follow up, endotherapy methods, success rates and complication rates. A random-effect model was used to pool the effect size across studies. Heterogeneity testing and publication bias assessment were performed. Multivariate regression analysis was performed to identify predictors of successful endoscopic therapy. Results Of 381 articles reviewed, 23 studies with 874 patients met the inclusion criteria. All were case series with suboptimal quality. Endoscopic therapy included minor papilla sphincterotomy, minor papilla sphincteroplasty and dorsal duct stenting. Mean follow-up duration was 37 months. The rate of “improvement” as defined by authors after endoscopic therapy varied significantly across studies, ranging from 31-96%: 589/874 patients were reported to have improved, corresponding to a pooled efficacy rate of 67.5% (95% confidence interval [CI] 0.610-0.734; P=0.0001). The pooled rate of pancreatitis after endoscopic retrograde cholangiopancreatography was 10.1% (95%CI 0.084-0.124; 2-sided P=0.0001). On subgroup analysis, patients with recurrent acute pancreatitis had better endoscopic outcomes (pooled efficacy rate 76%, 95%CI 0.712-0.803, P=0.0001). Dorsal duct stenting and longer follow up were the only parameters predictive of successful endotherapy. Significant heterogeneity was observed within and across studies. Conclusions Endoscopic efficacy in pancreas divisum is estimated at 67.5%. Available studies are of poor quality with significant heterogeneity. Comparative studies with rigorous methodology are needed. Keywords Pancreas divisum, endoscopic therapy, minor papilla sphincterotomy, meta-analysis, systematic review, recurrent acute pancreatitis, chronic pancreatitis Ann Gastroenterol 2017; 30 (5): 550-558
📖 Papers frequently viewed together
141 Citations
7 Authors (Rajan Kanth, ..., Praveen K. Roy)
33 Citations
68 Citations
References39
Newest
#1Brian Hutton (U of O: University of Ottawa)H-Index: 66
#2Georgia Salanti (UoI: University of Ioannina)H-Index: 76
Last. David Moher (U of O: University of Ottawa)H-Index: 129
view all 17 authors...
The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISM...
1,883 CitationsSource
#1Alberto Mariani (UniSR: Vita-Salute San Raffaele University)H-Index: 27
#2Milena Di Leo (UniSR: Vita-Salute San Raffaele University)H-Index: 17
Last. Pier Alberto Testoni (UniSR: Vita-Salute San Raffaele University)H-Index: 39
view all 8 authors...
AIM: To assess the rate of relapses of acute pancreatitis (AP), recurrent AP (RAP) and the evolution of endosonographic signs of chronic pancreatitis (CP) in patients with pancreas divisum (PDiv) and RAP. METHODS: Over a five-year period, patients with PDiv and RAP prospectively enrolled were divided into two groups: (1) those with relapses of AP in the year before enrollment were assigned to have endoscopic therapy (recent RAP group); and (2) those free of recurrences were conservatively manage...
24 CitationsSource
#1Helene Moustgaard (Cochrane Collaboration)H-Index: 4
#2Segun Bello (Cochrane Collaboration)H-Index: 9
Last. Asbjørn Hróbjartsson (Cochrane Collaboration)H-Index: 57
view all 4 authors...
Abstract Objectives The degree of bias in randomized clinical trials varies depending on whether the outcome is subjective or objective. Assessment of the risk of bias in a clinical trial will therefore often involve categorization of the type of outcome. Our primary aim was to examine how the concepts “subjective outcome” and “objective outcome” are defined in methodological publications and clinical trial reports. To put this examination into perspective, we also provide an overview of how out...
23 CitationsSource
#1Natsuyo YamamotoH-Index: 32
#2Hiroyuki IsayamaH-Index: 65
Last. Kazuhiko KoikeH-Index: 91
view all 12 authors...
Abstract A subpopulation of patients with pancreas divisum experience symptomatic events such as recurrent acute pancreatitis and chronic pancreatitis. Minor papilla sphincterotomy has been reported as being an effective treatment. The aim of this study was to evaluate the safety and efficacy of endoscopic balloon dilation for the minor papilla. Between 2000 and 2012, 16 patients were retrospectively included in this study. After endoscopic balloon dilation for the minor papilla was received, a ...
15 CitationsSource
#1Gregory Lutzak (Virginia Mason Medical Center)H-Index: 2
#2Michael Gluck (Virginia Mason Medical Center)H-Index: 27
Last. Richard A. Kozarek (Virginia Mason Medical Center)H-Index: 88
view all 4 authors...
Background Pancreas divisum patients with focal obstruction of the minor papilla and resulting dilation of the dorsal pancreatic duct [a santorinicele (SC)] have been reported to improve with endoscopic sphincterotomy of the minor papilla (ESMP). In this study, we assess the long-term efficacy of ESMP in SC patients.
7 CitationsSource
#1Tarun Rustagi (UConn: University of Connecticut)H-Index: 22
#2Michael Golioto (Hartford Hospital)H-Index: 5
Objective The aim of this study was to determine the diagnosis and endoscopic management of pancreas divisum with results from long-term experience at our institution. Methods A prospectively collected database of all patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with the diagnosis of pancreas divisum at our institution from January 2001 to April 2010 was retrospectively analyzed. Results A total of 45 patients were identified with pancreas divisum with 62 ERCP pro...
20 CitationsSource
#1D. K. Bhasin (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 7
#1Deepak K. Bhasin (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 31
Last. Kartar Singh (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 34
view all 9 authors...
Context The results of endoscopic drainage in pancreas divisum with chronic pancreatitis have been debatable. Objective To evaluate clinical presentation and long term results of endoscopic therapy in patients of calcific and non-calcific chronic pancreatitis with pancreas divisum. Patients and Methods Between 1996 and 2011, 48 patients (32 males and 16 females) with chronic pancreatitis and pancreas divisum were treated endoscopically. Patients were considered to have clinical success if they h...
11 CitationsSource
#1Gregory Borak (MUSC: Medical University of South Carolina)H-Index: 4
#2Joseph RomagnuoloH-Index: 38
Last. Peter B. CottonH-Index: 69
view all 5 authors...
OBJECTIVES: To assess the long-term outcomes of endoscopic minor papilla therapy in a spectrum of symptomatic patients with pancreas divisum. METHODS: Patients with pancreas divisum coded in a prospective database as having had minor papilla endotherapy (July 1997-May 2003, n = 145) were grouped into 3 categories: (1) acute recurrent pancreatitis, (2) chronic pancreatitis, and (3) chronic/recurrent epigastric pain. Telephone follow-up was conducted (78% of patients), including questions regardin...
76 CitationsSource
#1Zhuan Liao ('SMMU': Second Military Medical University)H-Index: 15
#2R. GaoH-Index: 1
Last. Zhao-Shen LiH-Index: 59
view all 8 authors...
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. M...
77 CitationsSource
#1Lyssa N. Chacko (University of Colorado Denver)H-Index: 1
#2Yang K. Chen (University of Colorado Denver)H-Index: 27
Last. Raj J. Shah (University of Colorado Denver)H-Index: 43
view all 3 authors...
Background Long-term outcomes of minor papilla endotherapy (MPE) in pancreas divisum are limited. Objective To determine the efficacy of MPE in symptomatic pancreas divisum subgroups. Design This was a retrospective study of patients from an endoscopy database. The data collection instrument included preprocedure and postprocedure pain score, narcotic use, acute pancreatitis episodes, emergency department visits, and hospitalizations. A follow-up was obtained by chart review and telephone contac...
68 CitationsSource
Cited By16
Newest
#1D. de Jong (EUR: Erasmus University Rotterdam)H-Index: 4
#2Pauline M. Stassen (EUR: Erasmus University Rotterdam)H-Index: 3
Last. Pieter J.F. de Jonge (EUR: Erasmus University Rotterdam)H-Index: 7
view all 0 authors...
Background and study aims Although the majority of patients with pancreas divisum (PDiv) are asymptomatic, a subgroup present with recurrent pancreatitis or pain for which endoscopic therapy may be indicated. The aim of this study was to evaluate success rates and long-term outcomes of endoscopic treatment in patients with symptomatic PDiv. Patients and methods A multicenter, retrospective cohort study was performed. Patients with symptomatic PDiv presenting with recurrent acute pancreatitis (RA...
Source
#1Jorge D. MachicadoH-Index: 13
#2Dhiraj YadavH-Index: 52
Source
#1Douglas S. FishmanH-Index: 19
#2Paola De AngelisH-Index: 18
Last. Victor L. FoxH-Index: 30
view all 4 authors...
Source
Abstract Background We aimed to assess factors impacting the endoscopic minor papilla sphincterotomy (EMPS) success rate, clinical efficacy, and safety in a large cohort of patients with symptomatic pancreas divisum (PD). Methods Retrospective study including patients with PD referred to the Pancreas Institute of Verona from May 2009 to May 2020 to undergo EMPS. The whole population was analyzed to assess EMPS technical success, defined as the rate of deep cannulation of the dorsal duct. Patient...
Source
#1Mitsuyoshi Suzuki (Juntendo University)H-Index: 11
#2Kei Minowa (Juntendo University)H-Index: 7
Last. Toshiaki Shimizu (Juntendo University)H-Index: 41
view all 4 authors...
Acute recurrent pancreatitis (ARP) is defined as 2 distinct episodes of acute pancreatitis (AP), while chronic pancreatitis (CP) is caused by persistent inflammation of the pancreas. ARP and CP in children are caused by genetic mutations, autoimmune pancreatitis, congenital pancreatic abnormalities, and other conditions. ARP is frequently a precursor to CP, and both are thought to be on the same disease continuum. In particular, genetic factors are associated with early progression of ARP to CP....
1 CitationsSource
#1Ana Dugic (KI: Karolinska Institutet)H-Index: 1
#2Sara Nikolic (KI: Karolinska Institutet)H-Index: 2
Last. Miroslav Vujasinovic (Karolinska University Hospital)H-Index: 13
view all 8 authors...
Background: Except for pancreas divisum (PD), the prevalence of anatomic variants of the main pancreatic duct (MPD) seems to be insufficiently investigated. To date, their role in the occurrence of...
1 CitationsSource
#1Cecil G Wood (NU: Northwestern University)H-Index: 5
#2Camila Lopes Vendrami (NU: Northwestern University)H-Index: 6
Last. Frank H. Miller (NU: Northwestern University)H-Index: 71
view all 5 authors...
Developmental anomalies of the pancreas include more common entities such as pancreas divisum and annular pancreas, and unusual entities such as heterotopic pancreas. While these anomalies can present a diagnostic challenge to the radiologist, when the pancreatic tissue involved in these processes develops pancreatitis, the radiographic appearance can present a diagnostic dilemma. Awareness of these pancreatic anomalies and familiarity with their appearance when inflamed is necessary to distingu...
1 CitationsSource
#2Neal Bhutiani (University of Louisville)H-Index: 13
Last. Gary C. Vitale (University of Louisville)H-Index: 28
view all 6 authors...
Introduction Appropriately selecting patients with chronic pancreatitis associated with pancreas divisum (PD) for endoscopic retrograde cholangiopancreatography (ERCP)–based therapy versus surgery remains difficult. The objective of this study was to identify factors that predict success or failure of ERCP for treatment of chronic pancreatitis in PD.
Source
Source
#1Aditya Gutta (IU: Indiana University)H-Index: 2
#1Aditya Gutta (IU: Indiana University)
Last. Stuart Sherman (IU: Indiana University)H-Index: 95
view all 3 authors...
ABSTRACTIntroduction: Pancreas divisum is the most common congenital malformation of the pancreas with the majority asymptomatic. The etiological role, pathogenesis, clinical significance and manag...
9 CitationsSource