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Conference News Digestive Disease Week

Pancreatitis Prevention: Just a Myth?

A major study finds no benefit from a common surgery long used to prevent pancreatitis.

Reuters

A commonly used endoscopic intervention for preventing pancreatitis shows no benefit, according to a new study.

Pancreas divisum, a congenital anomaly present in approximately 10% of the population, is characterized by failure of the pancreatic ducts to fuse. Although often asymptomatic, it can contribute to recurrent acute pancreatitis, a serious and painful condition.

Retrospective studies have suggested that endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) reduces acute pancreatitis episodes in 50% to 70% of patients with pancreas divisum.

However, ERCP itself carries risks, including acute pancreatitis in 10%–20% of patients, and may result in adverse events such as papillary stenosis, which can cause ongoing pancreatic symptoms, study author Gregory Cote, MD, MS, of Oregon Health & Science University, noted at Digestive Disease Week.

Despite these risks, prior to this investigation, no randomized trials had compared miES with sham intervention.

The study evaluated 148 patients with pancreas divisum and a median of three prior acute pancreatitis episodes who were randomly assigned to receive miES or a sham procedure.

At a median follow-up of 33.5 months, there was no statistically significant difference in acute pancreatitis recurrence between groups. Additionally, no differences were observed in the proportion of patients reporting pancreas-related pain beyond one month postprocedure or in rates of chronic pancreatitis, diabetes, or exocrine pancreatic insufficiency.

“These findings are striking, given that many clinicians have advocated for this intervention for decades,” Cote stated.

Current guidelines recognize pancreas divisum as a risk factor for pancreatitis and recommend consideration of ERCP as a treatment option. According to Cote, these recommendations are likely to change based on the study results.

He added that some patients with ductal strictures or obstruction might still benefit from ERCP; however, such patients were excluded from this trial.