Accurate diagnosis of pancreas divisum by linear-array endoscopic ultrasonography

Background and Study Aims: During linear-array endoscopic ultrasonography (EUS), the main pancreatic duct can be followed continuously from the major papilla into the pancreatic body in most patients. Often, the duct can also be seen crossing a sonographic border between the ventral and dorsal pancreatic anlagen. It was hypothesized that the presence of either feature excludes pancreas divisum, whereas the absence of these features suggests complete pancreas divisum. Patients and Methods: Pancreas divisum was sought during all linear-array EUS examinations conducted between July 1999 and June 2003. Charts were reviewed retrospectively, and patients who underwent endoscopic retrograde pancreatography after, but not before, EUS were included in the study. Results: A total of 162 patients had EUS before ERCP. Adequate evaluation of the pancreatic duct was possible in 78% of the patients. The prevalence of pancreas divisum was 13.6%. In patients with adequate duct visualization, the sensitivity, specificity, and positive and negative predictive values for EUS were 95%, 97%, 86%, and 99%, respectively. The overall accuracy of EUS for identifying pancreas divisum was 97% in this subgroup. Conclusion: Adequate EUS evaluation of pancreas divisum was possible in most cases. Linear-array EUS is a promising diagnostic test for pancreas divisum.