Pancreas divisum and its association with choledochal sphincter stenosis. Diagnosis by endoscopic retrograde cholangiopancreatography and endoscopic biliary manometry.

Choledochal sphincter stenosis was demonstrated in 37 of 90 patients with pancreas divisum. In 21 of the patients, stenosis was diagnosed during ERCP by endoscopic calibration of the choledochal sphincter, delayed drainage of contrast material from the bile duct, or a dilated common duct with or without elevation of the serum alkaline phosphatase level. In 12 patients, stenosis was diagnosed during endoscopic manometry with the demonstration of elevated basal choledochal sphincter pressures. Stenosis was initially diagnosed during surgery in four patients. Common duct diameters were normal in all patients who had not had cholecystectomy. Choledochal sphincter stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. The surgical approach to patients with pancreas divisum and intractable obstructive pain should include sphincteroplasty of both the major and minor sphincters rather than the minor sphincter alone.