Role of Endoscopic Ultrasound in Diagnosis and Management of Pancreas Divisum: A Case Study and Literature Review

The long-term efficacy of endoscopic treatment of pancreas divisum is controversial. This review focuses on recent literature on the role of endoscopic ultrasonography (EUS) as effective clinical support in the diagnosis and management of pancreas divisum. A challenging case study in a patient with pancreas divisum affected by recurrent acute pancreatitis and chronic pain is also reported. Our methodology was developed from a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive electronic search across multiple databases, including Medline/PubMed, EMBASE, Medline/Metacrawler and the Cochrane Library, to identify relevant publications for this systematic review was conducted. A total of 308 articles were found. According to EMBASE grouping criteria, 31 articles were considered major clinical studies and were analysed, reporting for each study the relevant clinical features. In the majority of studies examined, EUS proved useful in diagnosing a pancreatic divisum. The EUS diagnostic yield was reported to have a sensitivity ranging from 51% to 95% and high diagnostic accuracy up to 97%. EUS has shown high sensitivity and specificity in diagnosing pancreas divisum. Studies indicate that EUS can achieve sensitivity rates ranging from 80% to 100% and specificity rates around 97% to 100% for detecting pancreas divisum. Based on these figures, EUS is the most reliable imaging system in terms of diagnostic capability compared with other imaging systems.