SpHincterotomy for Acute Recurrent Pancreatitis

Inclusion Criteria:

1. Patient must consent to be in the study and must have signed and dated an approvedconsent form.

2. >18 years

3. Two or more episodes of acute pancreatitis, with each episode meeting two of thefollowing three criteria:

• abdominal pain consistent with acute pancreatitis (acute onset of a persistent,severe, epigastric pain often radiating to the back)

• serum lipase activity (or amylase activity) at least three times greater thanthe upper limit of normal

• characteristic findings of acute pancreatitis on CECT, MRI or transabdominalultrasonography

4. At least one episode of acute pancreatitis within 24 months of enrollment

5. Pancreas divisum confirmed by prior MRCP that is reviewed by an abdominalradiologist at the recruiting site.

6. By physician assessment, there is no certain explanation for recurrent acutepancreatitis.

7. Subjects must be able to fully understand and participate in all aspects of thestudy, including completion of questionnaires and telephone interviews, in theopinion of the clinical investigator

Exclusion Criteria:

1. Prior minor papilla therapy (endoscopic or surgical)

2. Calcific chronic pancreatitis, defined as parenchymal or ductal calcificationsidentified on computed tomography or magnetic resonance imaging scan that isreviewed by an expert radiologist at the recruiting site.

3. Main pancreatic duct stricture*

4. Presence of a structural etiology for acute pancreatitis, such as anomalouspancreatobiliary union, periampullary mass, or pancreatic mass lesion on imaging*

5. Presence of a local complication from acute pancreatitis which requirespancreatogram

6. Regular use of opioid medication for abdominal pain for the past three months

7. Medication as the etiology for acute pancreatitis by physician assessment

8. TWEAK score ≥ 4