Table 1.
Potential causes of pancreatic ductal obstruction in acute recurrent pancreatitis
| Potential causes | Diagnostic evaluation patient selection | Potential treatment strategies |
| Congenital variants | ||
| -PD ± Santorinicele | S-MRCP | ERCP ± EPS at the minor papilla |
| ± transient dorsal duct stenting | ||
| -APBU | S-MRCP | ES |
| -Choledochocele | S-MRCP | EBS |
| -TypeI& IV choledochal cyst | S-MRCP | Surgical resection + HJ |
| -Duodenal duplication cyst | S-MRCP | Endoscopic snare resection |
| or surgical resection | ||
| -Annular pancreas | S-MRCP | ERCP + EPS |
| or surgical gastrojejunostomy | ||
| Acquired obstructive conditions | ||
| -Suspected neoplasm | ||
| ampullary tumor | EUS, S-MRCP | Curative/palliative endotherapy |
| MPD stricture | EUS, S-MRCP | or |
| IPMT | EUS, S-MRCP | surgery |
| -Suspected early CP | EUS, S-MRCP | ERCP + EPS |
| ± transient MPD stenting | ||
| -Groove pancreatitis (CDDW) | EUS, S-MRCP | ERCP + dual ES + MPD stenting |
| or surgery or somatostatin | ||
| -Pancreatic SOD typeI | ||
| Type II | S-MRCP | ERCP + dual ES + transient MPD stenting |
| Type III |
PD: Pancreas divisum; APBU: Anomalous pancreaticobiliary union; MPD: Main pancreatic duct; IPMT: Intraductal papillary mucinous tumor; CP: Chronic pancreatitis; CDDW: Cystic dystrophy of the duodenal wall; SOD: Sphincter of Oddi dysfunction; S-MRCP: Secretin-enhanced magnetic resonance cholangiopancreatography; EUS: Endoscopic ultrasonography; ERCP: Endoscopic retrograde cholangiopancreatography; EPS: Endoscopic pancreatic sphincterotomy; ES: Endoscopic sphincterotomy; EBS: Endoscopic biliary sphincterotomy; HJ: Hepaticojejunostomy.