Pancreas divisum (PD) is the most common congenital pancreatic duct anomaly. Only a minority of patients become symptomatic, and the role of minor papilla sphincterotomy remains debated. We report outcomes of endoscopic therapy in symptomatic PD.

A retrospective, descriptive, single-center study including 21 patients with PD, of whom 16 were symptomatic and underwent therapeutic ERCP between 2018 and 2025.Collected data included clinical presentation, anatomical type, pancreatic duct stones, endoscopic interventions, complications, and clinical outcomes. Median follow-up was 29 months.

Technical success: successful minor papilla sphincterotomy with adequate ductal drainage and/or stent placement.

Clinical success: complete or significant improvement of symptoms (abdominal pain, recurrent pancreatitis) without the need for surgery.

Among the 21 patients with PD, 16 were symptomatic:

acute pancreatitis: n = 5

recurrent acute pancreatitis: n = 7

chronic pancreatitis: n = 4

The remaining 5 patients had an incidental diagnosis of PD during MRI workup for CBD stones and were not included in the therapeutic analysis.

The sex ratio among symptomatic patients was 0.77 (7 men, 9 women), with a mean age of 28.6 years (range 11–63).

Among the 16 symptomatic patients:10 (62.5%) had complete PD, and 6 (37.5%) had incomplete PD

Minor papilla sphincterotomy with stent placement was performed in 15 of the 16 symptomatic patients.There was one technical failure due to a tight stenosis, requiring surgical bypass (Wirsungo-jejunostomy).No procedure-related mortality or complications occurred.

All 15 successfully treated patients improved clinically:

• 12 after a single procedure
• 3 after three procedures
• 1 after four procedures

Minor papilla sphincterotomy with stent placement is technically feasible and clinically effective for symptomatic pancreas divisum. All successfully treated patients showed symptom improvement, with no procedure-related complications in our series