ERCP with minor papillotomy does little to reduce pancreatitis recurrence or related sequelae

For patients with unexplained acute recurrent pancreatitis and pancreas divisum, performing endoscopic retrograde cholangiopancreatography (ERCP) with minor papillotomy does not appear to lower the risk of another episode of acute pancreatitis or related sequelae, according to a study.

The study included 148 adults with at least two episodes of acute pancreatitis and pancreas divisum (mean age 54 years, 68.2 percent female, 87.2 percent White). The mean lifetime acute pancreatitis episodes were three, and the mean duct diameter was 2.2 mm.

The participants were randomly assigned to undergo ERCP with minor papillotomy (n=75) or sham ERCP (n=73). The development of acute pancreatitis more than 30 days after randomization was the primary outcome. Secondary outcomes included acute pancreatitis episode frequency and development of chronic calcific pancreatitis, diabetes, and exocrine pancreatic dysfunction. The median follow-up was 34 months.

Compared with sham ERCP, ERCP with minor papillotomy group was not associated with a significant reduction in the incidence of acute pancreatitis during follow-up (34.7 percent vs 43.8 percent; adjusted hazard ratio, 0.83, 95 percent confidence interval [CI], 0.49–1.41). The incidence rate ratio for acute recurrent pancreatitis episode frequency was 0.25 (95 percent CI, 0.18–0.34) with ERCP with minor papillotomy vs 0.30 (95 percent CI, 0.23–0.41) with sham ERCP.

Likewise, no between-group differences were observed in the frequency and incidence of chronic calcific pancreatitis (4 percent in the ERCP with minor papillotomy group vs 2.7 percent in the sham ERCP group; risk difference [RD], 0.01, 95 percent CI, −0.05 to 0.07), diabetes (15.8 percent vs 12.8 percent, respectively; RD, 0.03, 95 percent CI, −0.13 to 0.19), and exocrine pancreatic dysfunction (7.7 percent vs 17.2 percent; RD, −0.10, 95 percent CI, −0.27 to 0.08).

Acute pancreatitis within 30 days of randomization was more common in the ERCP with minor papillotomy group than in the sham ERCP group (14.7 percent vs 8.2 percent; RD, 0.06, 95 percent CI, −0.04 to 0.17).