Pancreas divisum (PD) is one of the causes of recurrent acute pancreatitis (RAP). Its diagnosis may be missed that would result with chronic pancreatitis and even duktal adenocarcinoma in a rare case. Treatment aims to provide a sustained dilation of minor papillary orifice. We aimed to assees the eficacy of multiple plastic stenting of main pancreatic duct through minor papilla in PD cases.

We evaluated the data of 24 PD patients with RAP treated between 2011 and 2023, with multiple plastic stenting with at least 24 months of follow up.

There were 11 females and 13 males with median age of 44 (Range:17-65). The patients underwent pancretic sphincterotomy with plastic stents 7-10 F. After 6 months we either incresed the size of the stent tor increased the number of stents according to the size of the main pancreatic duct. We continued 6 monthly intervals until a satisfactory calibration is obtained. Median number of plastic stents were two (1-3). Median number of sessions was 4 (3-6). We did baloon dilation with 4-8 mm ballons for some patients as well. The maximal size of stents was two 10 F plus one 7 F. After retrieveal of the stents, while nor RAP happened in 19 patients, RAP happened with stricture of minor papillary orifice in 5 patients who required further endoscopic treatment. All recurrences happened in the second year follow up: median 17 months (range 15-23). No serious side-effect happened.

Management of pancreas divisum with multiple stenting is safe and has long-term benefit in 79.1 % (19/24) of patients. However in longer term follow up more recurrences may be expected. Recently we treated some patients with SEMS and data arising from small numbers are encouraging with less sessions (Unpublished observation).