Clinical importance of main pancreatic duct variants and possible correlation with pancreatic diseases

Abstract

Background: Except for pancreas divisum (PD), the prevalence of anatomic variants of the main pancreatic duct (MPD) seems to be insufficiently investigated. To date, their role in the occurrence of pancreatic exocrine insufficiency (PEI) and morphological changes suggestive of chronic pancreatitis (CP) has remained unclear.

Methods: A systematic review was performed, searching MEDLINE and Web of Science, limited to articles published between 1960 and 1 June 2019.

Results: Our review included a total number of 3234 subjects. The most common variant of MPD was type 3, followed by type 1, indicating MPD drainage pattern into major papilla (MP) as the most frequent. A sub-variant of type 3, known as ‘reverse pancreas divisum’ had a prevalence of 2.2%. Type 4 variant- PD, was found in 6.4% of all cases. The most common sub-variant of PD was complete PD, followed by incomplete PD and variant with MPD as only pancreatic duct. Type 5 variant (including ansa pancreatica) was present in 2.9% of subjects. Apart from one study with a significantly higher frequency of morphological changes suggestive of CP in patients with ansa pancreatica, the studies stated no significant association between pancreatic disease and MPD variants. Furthermore, only one study examined the influence of MPD variants on exocrine pancreatic function. Although equivocal, this association is most likely found to be insignificant.

Conclusion: To elucidate linkage between MPD variants and the occurrence of chronic pancreatitis and impairment of pancreatic exocrine function, further clinical investigations are warranted.

Keywords:

• Main pancreatic duct
• variants
• patterns
• pancreatic exocrine insufficiency
• pancreatitis

Author contributions

Dugic A and Vujasinovic M contributed to the study’s conception and design, literature review and selection of eligible studies, analysis and interpretation of data and drafting of the manuscript; Nikolic S contributed to the literature review, selection of eligible studies, data analysis and critical revision and editing; Mühldorfer S, Bulajic M, PozziMucelli R, Tsolakis AV contributed to critical revision and editing; Löhr JM contributed to the study’s conception and design, literature review and analysis, drafting of the manuscript and critical revision and editing.

Disclosure statement

Vujasinovic M and Löhr JM have worked as speakers for Mylan and Abbott Laboratories. Nikolic S has worked as a speaker for Mylan, Servier and Ferring. The authors declare no potential conflicts of interest and no financial support regarding presenting manuscript.

PRISMA 2009 checklist

The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.