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PANCREATIC SPHINCTEROTOMY IN RECURRENT PANCREATITIS ASSOCIATED WITH BRANCH-DUCT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: A SINGLE-CENTER RETROSPECTIVE STUDY

Salvatore Crucillà 1, Irene Gasparini 1, Antonio Amodio 2, Nicolò de Pretis 3, Federico Caldart 1, Giulia De Marchi 2, Pietro Campagnola 2, Annalisa Tortora 2, Matilde Visintainer 1, Laura Bernardoni 4, Armando Gabbrielli 4, Maria Cristina Conti Bellocchi 3, Stefano Francesco Crinò 3, Luca Frulloni 3

Affiliations

1 University of Verona, Verona, Italy

2 Gastroenterology B Unit, Pancreas Center, University of Verona, Italy, Verona, Italy

3 University of Verona, Verona, Italy|||Gastroenterology B Unit, Pancreas Center, University of Verona, Italy, Verona, Italy

4 Santa Chiara Hospital, Trento, Italy

Summary

AI Generated

Pancreatic sphincterotomy achieved clinical success in 81.8% of patients with branch-duct intraductal papillary mucinous neoplasms and recurrent pancreatitis in a retrospective single-center study of 33 patients.

Clinical success, defined as complete resolution or at least 50% reduction in pancreatitis episodes, was achieved in 81.8% of cases, with 72.7% experiencing no further acute pancreatitis episodes after sphincterotomy and 9.1% experiencing reduced episode frequency.
Adverse events occurred in 15% of patients, including 12% with mild post-ERCP pancreatitis and 3% with intraprocedural bleeding, with no perforations reported.
During follow-up, worrisome features emerged in 15% of patients, no high-risk stigmata were identified, and no cases of IPMN degeneration were observed.
Among the 18.2% of non-responders, three underwent a second sphincterotomy with two achieving clinical improvement, and three underwent duodenocephalopancreasectomy including one for concomitant pancreatic ductal adenocarcinoma unrelated to IPMN progression.
The authors conclude that pancreatic sphincterotomy appears to be a safe and effective option for managing recurrent pancreatitis in selected branch-duct IPMN patients, potentially reducing the need for surgery.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are frequently associated with acute (AP) or recurrent pancreatitis (RP), likely due to the mucin-induced obstruction of the main pancreatic duct (MPD). According to the 2024 Kyoto Guidelines, pancreatitis represents an indication for surgical evaluation in IPMN patients. However, pancreatic sphincterotomy (PS) may represent a less invasive alternative for patients who are unfit for surgery or as a bridge to surgery, aiming to reduce the risk of further pancreatitis episodes.

Aims & Methods

This single-center retrospective study aimed to assess the efficacy and safety of PS in patients with BD-IPMN and RP. We included 33 patients who underwent PS between 2016 and 2023, with at least 12 months of follow-up. Patients with other causes of RP or prior pancreatic surgery were excluded. The frequency of pancreatitis episodes before and after PS was compared. Clinical success was defined as complete resolution or ≥50% reduction in pancreatitis episodes. Adverse events, presence of worrisome features (WF), and progression to high-risk stigmata (HRS) were evaluated. Statistical analysis was performed using paired t-test and Fisher’s exact test, with p < 0.05 considered significant.

Results

Among the 33 patients analyzed (39.4% female, 60.6% male, mean age 59 ± 13.9 years) clinical success was achieved in 81.8% of the cases. Specifically, 72.7% of the patients experienced no further AP episodes after PS and 9.1% experienced a reduction in episode frequency, while 18.2% of patients did not respond to treatment. Adverse events occurred in 15% of patients, including: 12% with post-ERCP pancreatitis (all mild) and 3% with intra-procedural bleeding; no perforations were reported. During follow-up WF emerged in 5 patients (15%), while no cases of HRS were identified. Among the 6 non-responders, 3 underwent a second PS, with 2 achieving clinical improvement, and 3 underwent duodenocephalopancreasectomy (DCP), including 1 for a concomitant pancreatic ductal adenocarcinoma (PDAC) unrelated to IPMN progression. Notably, no cases of IPMN degeneration were observed in the series

Conclusion

Pancreatic sphincterotomy appears to be a safe and effective approach for managing recurrent pancreatitis in patients with BD-IPMN, potentially reducing the need for surgery in selected cases.

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

A scope, a needle and a stent: All you need in treating pancreatitis (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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