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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-ray to treat problems of the bile and pancreatic ducts. A gastroenterologist uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. ERCP with minor papilla sphincterotomy (incision of the opening of the pancreatic duct) is a promising treatment option for those with pancreas divisum and acute pancreatitis, but there are limited data to show that this intervention works.


The SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a randomized trial supported by the National Institute of Health (NIH) with more that 15 medical centers in the U.S., Canada and Europe.  The goal of the study is to determine if this ERCP procedure benefits patients with recurrent acute pancreatitis and pancreas divisum.


This NIH-sponsored Randomized Clinical Trial is currently enrolling subjects to learn whether ERCP with sphincterotomy is beneficial in patients with acute recurrent pancreatitis and pancreas divisum.



Pancreas divisum occurs during development, when the two parts of the pancreatic duct do not completely fuse together. This occurs in approximately 7-10% of all individuals.


The majority of individuals with pancreas divisum will not experience symptoms. However, a small group of individuals may experience, abdominal pain, nausea, vomiting and pancreatitis (acute and chronic).


The best non invasive way to diagnose pancreas divisum is by a special magnetic resonance imaging (MRI) exam called Magnetic Resonance Cholangiopancreatography (MRCP). 


Pancreas divisum in individuals with no symptoms or chronic abdominal pain do not require treatment. Treatment of those with two or more episodes of acute pancreatitis has not been well established. Currently, there is an ongoing research study (SHARP) that is learning more about treatment options.


Acute pancreatitis is among the most common gastrointestinal causes for hospitalization in the U.S. Roughly one in five patients with acute pancreatitis will go on to have one or more episodes.




  • Severe and constant pain in the upper abdomen that might travel to the back 

  • Swollen and tender abdomen 

  • Nausea and vomiting

  • Fever             

  • In most cases of acute pancreatitis, digestive enzyme (amylase or lipase) levels are typically elevated 3 times the normal level. 

  • If blood tests are inconclusive, certain tests such as an MRI or CT scan can also diagnose acute pancreatitis.

  • Pain control 

  • Intravenous fluids

  • Treating the underlying causes (alcohol use, gallstones, high calcium, etc)

For patients with pancreas divisum, sometimes Endoscopic Retrograde Cholangiopancreatography (ERCP) is offered to patients who have suffered from two or more episodes of acute pancreatitis. Due to the risks of ERCP, this procedure is not typically offered to patients after one episode.

Currently, there is an ongoing research study (SHARP) that is learning more about ERCP in patients with pancreas divisum and acute pancreatitis.


©2019 by SHARP Trial, Charleston, SC