Minor Papillotomy for Treatment of Idiopathic Acute Pancreatitis With Pancreas Divisum

作者：Gregory A. Coté, Valerie L. Durkalski‐Mauldin, Evan L. Fogel, Dana C. Moffatt, Andrew Y. Wang, Luis F. Lara, Paul R. Tarnasky, James Leonard Buxbaum, Sun-Chuan Dai, Sreeni Jonnalagadda, Field F. Willingham, Andrew Ross, Rajesh N. Keswani, Sumant Inamdar, Truptesh H. Kothari, Timothy B. Gardner, Priya A. Jamidar, Srinivas Gaddam, Douglas K. Pleskow, Jeffrey J. Easler, B. Joseph Elmunzer, John Gerard Coneys, J. Shawn Mallery, Daniel S. Strand, Georgios I. Papachristou, Adam Slivka, Prashant S. Kedia, Ara B. Sahakian, Abdul M. Kouanda, Anh Ngoc Bao Phan, April R. Williams, Dana K. Andersen, José Serrano, Dhiraj Yadav, Haley L. Nitchie, Alexander M. Waters, Czarinna M. Posadas, Ann J. Manabat, Spencer K. Harris, Charÿsa Santos, Thiruvengadam Muniraj, Chloe J. Bennett, Rajiv Chhabra, Kimberly M. Stello, Charles C. Gabbert, Kevin McGrath, Kenneth E. Fasanella, Kelley Wood, Tina Tomko, Stuart Sherman, Shelly Winslow, Jeffrey T. Roesgen, Zack Jacob, Anja Rassmann, Lakin Underwood-Jacobs, Chelsea DiBella, Munazza Z. Ullah, Kayla L. Lopez, Walter Baldeon, Uchechi Okafor, Luke Roberts, Diane Alpine, Melony Ivekovic, Alejandro L. Vázquez, Melissa Galicia, Suzette E. Schmidt, Penny J. Doughty, Cheryl Shaw, Joseph Meza, Ross C. D. Buerlein, Dushant S. Uppal, Alexander Joseph Podboy, Rebecca Torrance · 发表于：JAMA · 年份：2026 · DOI：10.1001/jama.2025.23988 · 被引用次数：11 · 研究领域：Pancreatitis Pathology and Treatment、Gallbladder and Bile Duct Disorders、Pancreatic and Hepatic Oncology Research

Importance: Pancreas divisum is implicated as an obstructive cause for acute pancreatitis. Observational data suggest endoscopic retrograde cholangiopancreatography (ERCP) with minor papillotomy reduces the risk of pancreatitis episodes. Even though this endoscopic procedure is widely used in practice, clinical trials are lacking. Objective: To determine whether ERCP with minor papillotomy reduces the risk of acute pancreatitis among adults with unexplained acute recurrent pancreatitis and pancreas divisum. Design, Setting, and Participants: This multicenter, sham-controlled, double-blind randomized clinical trial enrolled adults with 2 or more episodes of acute pancreatitis and pancreas divisum. Adults with other etiologies for acute pancreatitis or concomitant chronic calcific pancreatitis were excluded. The trial was conducted between September 1, 2018, and August 30, 2024, at 21 referral centers in the US and Canada. Last follow-up occurred on February 15, 2025. Intervention: Participants were randomized in a 1:1 ratio to ERCP with minor papillotomy or sham ERCP. Main Outcomes and Measures: The primary outcome was development of acute pancreatitis more than 30 days after randomization as a time-to-event outcome. The secondary outcomes included acute pancreatitis episode frequency and development of chronic calcific pancreatitis, diabetes, and exocrine pancreatic dysfunction. Results: A total of 148 participants were randomized (mean age, 54 [SD, 19.5] years; 68.2% female;...