J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 10, Number 5, May 2018, pages 370-375

The Main Anatomical Variations of the Pancreatic Duct System: Review of the Literature and Its Importance in Surgical Practice

**Table 1.** Classification of the Articles According to the Number and Type of Patients, Type of Investigation, and Type of Study [3-5, 7, 9-14]
Author	No. of subjects	Type of subjects	Type of investigation	Type of article
*Only some of the patients included in the article were suitable for imaging of the pancreatic duct system. ERCP: endoscopic retrograde cholangiopancreatography; MRCP: magnetic resonance cholangiopancreatography.
Filippo et al [3]	350	Living patient	MRCP	Prospective study
Adibelli et al [4]	1,158	Living patient	MRCP	Retrospective cohort study
Bulow et al [5]	927	Healthy volunteers	Stimulating MRCP	Prospective study
Bang et al [7]	582	Living patient	ERCP	Retrospective cohort study
Kamisawa et al [9]	256/3,210*	Living patient	ERCP	Retrospective cohort study
Shahriah et al [10]	65	Cadaver	Autopsy of specimens	Prospective study
Kim HJ et al [11]	4,097/10,243*	Living patient	ERCP	Multicenter retrospective cohort study
Oracz et al [12]	300	Living patient	Medical records (non specified)	Retrospective cohort study
Uomo et al [13]	485/650*	Living patient	ERCP	Retrospective cohort study
Prasanna et al [14]	40	Cadaver	Autopsy of specimens	Prospective study

Table 1. Classification of the Articles According to the Number and Type of Patients, Type of Investigation, and Type of Study [3-5, 7, 9-14]

Author

No. of subjects

Type of subjects

Type of investigation

Type of article

*Only some of the patients included in the article were suitable for imaging of the pancreatic duct system. ERCP: endoscopic retrograde cholangiopancreatography; MRCP: magnetic resonance cholangiopancreatography.

Filippo et al [3]

350

Living patient

MRCP

Prospective study

Adibelli et al [4]

1,158

Living patient

MRCP

Retrospective cohort study

Bulow et al [5]

927

Healthy volunteers

Stimulating MRCP

Prospective study

Bang et al [7]

582

Living patient

ERCP

Retrospective cohort study

Kamisawa et al [9]

256/3,210*

Living patient

ERCP

Retrospective cohort study

Shahriah et al [10]

Cadaver

Autopsy of specimens

Prospective study

Kim HJ et al [11]

4,097/10,243*

Living patient

ERCP

Multicenter retrospective cohort study

Oracz et al [12]

300

Living patient

Medical records (non specified)

Retrospective cohort study

Uomo et al [13]

485/650*

Living patient

ERCP

Retrospective cohort study

Prasanna et al [14]

Cadaver

Autopsy of specimens

Prospective study

**Table 2.** Classification of the Articles According to the Number of Patients, Normal Pancreatic Duct Anatomy, and Variations [3-5, 7, 9-14]
Author	No. of subjects examined	Type of subjects	No. of normal	Pancreas divisum	Other specific types of anomalies
Filippo et al [3]	350	Living patient	321	18	11
Adibelli et al [4]	1,158	Living patient	1,091	54	13
Bulow et al [5]	927	Healthy volunteers	838	89	-
Bang et al [7]	582	Living patient	531	19	32
Kamisawa et al[9]	256/3,210	Living patient	175	81	-
Shahriah et al [10]	65	Cadaver	55	9	1
Kim HJ et al [11]	4,097/10,243	Living patient	4,054	40	3
Oracz et al [12]	300	Living patient	252	33	15
Uomo et al [13]	485/650	Living patient	437	26	22
Prasanna et al [14]	40	Cadaver	38	2	-
Total	8,260	8 living patients	7,792 (94.3%)	371 (4.5%)	97 (1.2%)
		1 healthy volunteers
		2 cadavers

Table 2. Classification of the Articles According to the Number of Patients, Normal Pancreatic Duct Anatomy, and Variations [3-5, 7, 9-14]

Author

No. of subjects examined

Type of subjects

No. of normal

Pancreas divisum

Other specific types of anomalies

Filippo et al [3]

350

Living patient

321

Adibelli et al [4]

1,158

Living patient

1,091

Bulow et al [5]

927

Healthy volunteers

838

Bang et al [7]

582

Living patient

531

Kamisawa et al[9]

256/3,210

Living patient

175

Shahriah et al [10]

Cadaver

Kim HJ et al [11]

4,097/10,243

Living patient

4,054

Oracz et al [12]

300

Living patient

252

Uomo et al [13]

485/650

Living patient

437

Prasanna et al [14]

Cadaver

Total

8,260

8 living patients

7,792 (94.3%)

371 (4.5%)

97 (1.2%)

1 healthy volunteers

2 cadavers

**Table 3.** Classification of Patients According to the Type of the Pancreatic Duct Course and Configuration [3-5, 7, 9-14]
Author	No. of subjects examined	Type 1	Type 2	Type 3	Type 4	Type 5	Other specific types of anomalies
*Patients with type 1, type2 and type 3 were not discriminated due to the different type of classification. ⁺Patients that could not be classified in one of the described types according to the classification that was used in this article. ^∧Patients with APBU were not discriminated from the types 1 to 5 but they were reported separately.
Adibelli et al [4]	1,158	521 (45%)	42 (3.6%)	528 (45.6%)	54 (4.6%)	13 (1.2%)	No annular pancreas, agenesis, hypoplasia, dorsal pancreas, accessory lobe, 2APBU (0.17%)^∧
Bulow et al [5]	927	209 (22.5%)	45 (4.8%)⁺	584 (63%)	89 (9.6%)	-	-
Shahriah et al [10]	65	5 (7.69%)	3 (4.6%)	47 (72.3%)	9 (13.8%)	-	1 duct in 3d papilla
Bang et al [7]	582	531 (91,2%)* non corresponding types	19 (3.3%)	-	32 (5.5%) duplication anomalies (5 number - 27 form variants)
Filippo et al [3]	350	321 (91.8%) non specified type	18 (5.2%)	-	11 ABPU (3%) no annular
Prasanna et al [14]	40	38 (95%)	Excluded from study	2 (5%)	-	-
Kamisawa et al [9]	256/3,210	175 (68.3%) non specified type	81 (31.6%)	-	74 ABPU (28.9%)^∧
Uomo et al [13]	485/650	437 (90,1%) non specified type	26 (5.3%)	-	22 Duplications (13 bifid MPD, 4 loop, 2 N-shaped, 3 ring shaped )
Kim HJ et al [11]	4,097/10,243	1,216 (37.7%) non specified type but with APD	2,838 (69.3%)	40 (0.49%)	-	2 annular (0.05%), 1 santorinocele, 30 APBU (4.1%)^∧
Oracz et al [12]	300	252 (84%) non specified type	33 (11%)	8 (2.7%)	4 ABPU, 3 rare (1%) anomalies
Total	8,260	7,792 (94.3%)	371 (4.5%)	21 (0.25%)	76 (0.92%)

Table 3. Classification of Patients According to the Type of the Pancreatic Duct Course and Configuration [3-5, 7, 9-14]

Author

No. of subjects examined

Type 1

Type 2

Type 3

Type 4

Type 5

Other specific types of anomalies

*Patients with type 1, type2 and type 3 were not discriminated due to the different type of classification. ⁺Patients that could not be classified in one of the described types according to the classification that was used in this article. ^∧Patients with APBU were not discriminated from the types 1 to 5 but they were reported separately.

Adibelli et al [4]

1,158

521 (45%)

42 (3.6%)

528 (45.6%)

54 (4.6%)

13 (1.2%)

No annular pancreas, agenesis, hypoplasia, dorsal pancreas, accessory lobe, 2APBU (0.17%)^∧

Bulow et al [5]

927

209 (22.5%)

45 (4.8%)⁺

584 (63%)

89 (9.6%)

Shahriah et al [10]

5 (7.69%)

3 (4.6%)

47 (72.3%)

9 (13.8%)

1 duct in 3d papilla

Bang et al [7]

582

531 (91,2%)* non corresponding types

19 (3.3%)

32 (5.5%) duplication anomalies (5 number - 27 form variants)

Filippo et al [3]

350

321 (91.8%) non specified type

18 (5.2%)

11 ABPU (3%) no annular

Prasanna et al [14]

38 (95%)

Excluded from study

2 (5%)

Kamisawa et al [9]

256/3,210

175 (68.3%) non specified type

81 (31.6%)

74 ABPU (28.9%)^∧

Uomo et al [13]

485/650

437 (90,1%) non specified type

26 (5.3%)

22 Duplications (13 bifid MPD, 4 loop, 2 N-shaped, 3 ring shaped )

Kim HJ et al [11]

4,097/10,243

1,216 (37.7%) non specified type but with APD

2,838 (69.3%)

40 (0.49%)

2 annular (0.05%), 1 santorinocele, 30 APBU (4.1%)^∧

Oracz et al [12]

300

252 (84%) non specified type

33 (11%)

8 (2.7%)

4 ABPU, 3 rare (1%) anomalies

Total

8,260

7,792 (94.3%)

371 (4.5%)

21 (0.25%)

76 (0.92%)

**Table 4.** Evaluation of Pancreas Divisum and Its Types
Pancreas divisum	Type 1	Type 2	Type 3
Adibelli et al [4]	24	20	10
Bang et al [7]	12	-	7
Bulow et al [5]	67	-	89
Kamisawa et al [9]	16	10	15
Total	119 (44%)	30 (11.11%)	121 (44.8%)

Table 4. Evaluation of Pancreas Divisum and Its Types

Pancreas divisum

Type 1

Type 2

Type 3

Adibelli et al [4]

Bang et al [7]

Bulow et al [5]

Kamisawa et al [9]

Total

119 (44%)

30 (11.11%)

121 (44.8%)