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This is the most common congenital anomaly of the pancreas and is seen in 5–14% of the general population. Pancreas divisum has long been associated with pancreatitis but the causality is suspect. In a large series of patients undergoing ERCP, there was no difference in the prevalence of pancreas divisum in the groups with and without pancreatitis [66]. In patients with idiopathic recurrent acute pancreatitis and pancreas divisum, genetic polymorphism/mutation in serine protease inhibitor Kazal type 1 (SPINK1) and cystic fibrosis transmembrane conductance regulator (CFTR) genes have been shown as important cofactors [67]. A randomized controlled trial (SHARP) is currently being conducted to evaluate the efficacy of minor papilla sphincterotomy in patients with recurrent AP and pancreas divisum.

Table 2.3 Independent risk factors for post‐ERCP pancreatitis.

Source : adapted from Dumonceau et al. [63].

	Odds ratio (95% confidence interval)
Patient‐related risk factors
Prior post‐ERCP pancreatitis	8.7 (3.2–23.8)
Female sex	3.5 (1.1–10.6)
Previous recurrent pancreatitis	2.5 (1.9–3.1)
Suspected sphincter of Oddi dysfunction	1.9 (1.4–2.6)
Younger patient age (<40 years old)	1.8 (1.3–2.6)
Absence of chronic pancreatitis	1.9 (1–3.48)
Normal serum bilirubin	1.9 (1.2–2.9)
Procedure‐related risk factor
Difficult cannulation (>10 minutes)	1.8 (1.1–2.7)
Repetitive pancreatic guidewire cannulation	2.8 (1.8–4.3)
Pancreatic duct injection	2.2 (1.6–3.0)
Pancreatic sphincterotomy	3.1 (1.6–5.7)
Endoscopic papillary large balloon dilatation of intact sphincter	4.5 (1.5–13.5)