Forty-five studies were included in the review: 17 assessed ERCP detection rates (n=31,413); 15 assessed endotherapy (one randomised controlled trial and 14 retrospective case series, n=520); and 13 assessed surgery (one prospective study and 12 retrospective case series, n=271).
The overall pooled endoscopic detection rate was 2.9%. Pooled rates were significantly lower in Asia (1.5%, six studies) than in Europe (6%, three studies) or USA (5.8%, eight studies) (p<0.001).
The proportion of patients with complete or partial pain relief following endotherapy (69.4%, range 33% to 100%) was similar to that following surgery (74.9%, range 50% to 100%, p=0.106). Response rates were similar for endotherapy and surgery when stratified according to type of pancreas divisum. Response rates were significantly higher among those with acute recurrent pancreatitis (81.2%, 15 studies) than for those with chronic pancreatitis (68.8%, seven studies) (p=0.029), which was significantly higher than the response rate for those with pain secondary to pancreas divisum (53.1%, nine studies) (p=0.030).