Adam Timothy, Malenstein Hannah Van, Laleman Wim
Department of Gastroenterology and Hepatology, Section of Liver & Biliopancreatic Disorders and Liver Transplantation, University Hospitals Leuven, KU Leuven, Belgium (Timothy Adam, Hannah Van Malenstein, Wim Laleman).
Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Münster, Germany (Wim Laleman).
Ann Gastroenterol. 2024 Sep-Oct;37(5):610-617. doi: 10.20524/aog.2024.0901. Epub 2024 Jul 12.
Meandering main pancreatic duct (MMPD) refers to an uncommon ductal variant of the normal smooth curvilinear course of the pancreatic duct. More specifically, MMPD is characterized by a hairpin (reverse Z-type) or loop (loop-type) turn in the pancreatic head. It has been suggested as a predisposing factor for the development of pancreatitis. Studies regarding treatment are scarce.
We conducted a narrative review of the current literature regarding MMPD. Additionally, we present a cohort of 9 symptomatic patients treated endoscopically at our tertiary center.
Seven retrospective cohort studies and 4 case reports were included in our review. Only 1 study focuses on the clinical significance of MMPD and describes a positive association between MMPD and the onset of pancreatitis, especially recurrent acute pancreatitis. Only 1 case reports an endoscopic treatment. In our cohort of 9 MMPD patients, 7 did indeed present with recurrent acute pancreatitis. Endotherapy provided substantial regression of symptoms in 6 patients, all of whom had signs of ductal hypertension.
Our review shows the scarcity of data regarding MMPD, especially concerning treatment, in the current literature. With our cohort, we not only hope to raise awareness of this often-neglected entity of recurrent acute pancreatitis, but also support the case for endotherapy for the first time in 9 symptomatic MMPD patients, especially in the presence of ductal hypertension.
蜿蜒型主胰管（MMPD）是指胰管正常平滑曲线走行的一种罕见的导管变异。更具体地说，MMPD的特征是胰头处呈发夹样（反向Z型）或环状（环型）转折。它被认为是胰腺炎发生的一个易感因素。关于其治疗的研究很少。
我们对当前有关MMPD的文献进行了叙述性综述。此外，我们还介绍了在我们三级中心接受内镜治疗的9例有症状患者的队列。
我们的综述纳入了7项回顾性队列研究和4例病例报告。仅有1项研究关注MMPD的临床意义，并描述了MMPD与胰腺炎发作，尤其是复发性急性胰腺炎之间的正相关关系。仅有1例病例报告了内镜治疗情况。在我们的9例MMPD患者队列中，7例确实表现为复发性急性胰腺炎。内镜治疗使6例患者的症状得到显著缓解，所有这些患者均有导管高压的体征。
我们的综述表明，当前文献中关于MMPD的数据稀缺，尤其是关于治疗方面。通过我们的队列研究，我们不仅希望提高对这种常被忽视的复发性急性胰腺炎实体的认识，而且首次为9例有症状的MMPD患者支持内镜治疗的情况，特别是在存在导管高压的情况下。
