Treatment of recurrent pancreatitis by endoscopic drainage of a duodenal duplication

Acute recurrent pancreatitis secondary to the rare association of a duodenal duplication cyst and a pancreas divisum

Duodenal duplication cysts are rare congenital anomalies that can cause acute pancreatitis. Pancreas divisum is also a congenital anomaly, often discovered incidentally, but is considered a possible cause of acute pancreatitis. We report the case of the combination of both anomalies causing recurrent episodes of acute pancreatitis in a young man. Endoscopic treatment by partial excision of the cyst with a polypectomy snare and sphincterotomy of the minor papilla was successful.

A case series of symptomatic intraluminal duodenal duplication cysts: presentation, endoscopic therapy, and long-term outcome (with video)

BACKGROUND

Duodenal duplication cysts are rare congenital anomalies. Symptomatic cases have classically been treated by surgical resection, which can be complex because of the close proximity of the cysts to the papilla.

OBJECTIVE

To describe a series of 8 patients with symptomatic duodenal duplication cysts who were treated endoscopically, with a special focus on the long-term outcome.

DESIGN

Retrospective case series.

SETTING

Three tertiary-care European academic hospitals.

PATIENTS

Eight patients, age 8 to 72 years, were treated endoscopically for symptomatic intraluminal duodenal duplication cysts between 1981 and 2006. Seven patients presented with acute pancreatitis, and one patient presented with jaundice.

INTERVENTION

Endoscopic incision and marsupialization of the cysts was performed by using a variety of endoscopic tools (needle-knife and regular sphincterotomes, cystotomes, and polypectomy snares).

MAIN OUTCOME MEASUREMENTS

Technical success of endoscopic intervention and long-term clinical recurrence of symptoms.

RESULTS

No major complications occurred. All patients remained asymptomatic at a median follow-up of 7.3 years.

LIMITATIONS

Retrospective study; the small number of patients.

CONCLUSIONS

The endoscopic treatment of symptomatic intraluminal duodenal duplication cysts is a safe and effective technique, with excellent long-term results. It represents a minimally invasive alternative to surgical resection and might be considered the preferred therapeutic modality for these cases.