Pancreas divisum (PD) is a frequent congenital variant, yet its association with pancreatic duct calculi remains insufficiently described. This study evaluates the prevalence, characteristics, and endoscopic outcomes of ductal stones in patients with PD.

We conducted a retrospective study including all patients managed for pancreatic duct stones between 2018 and 2025.

Among the 74 patients, 16 had PD. Clinical, anatomical, and therapeutic data were analyzed. Median follow-up was 29 months.

Among 74 patients referred for pancreatic duct calculi, 16 (21.6%) had PD. ERCP established the diagnosis in 8 cases (50%) and confirmed MRI findings in the remainder. Complete PD was identified in 10 patients (62.5%), and incomplete PD in 6 (37.5%).Seven patients had microlithiasis (<5 mm), eight had stones measuring 5–10 mm, and one had a stone >10 mm.Minor papilla sphincterotomy with duct clearance and stone extraction, followed by stent placement, was performed in all 16 patients. Clinical success was achieved in all cases (100%). One technical failure due to a severe stenosis required surgical bypass. No ERCP-related adverse events occurred.

Pancreas divisum accounted for a substantial proportion (21.6%) of patients presenting with pancreatic duct calculi. Stone formation was frequent even in cases of small-caliber calculi. Minor papilla sphincterotomy with temporary stenting proved safe and highly effective in symptomatic PD. These data support considering PD in the differential diagnosis of ductal calculi