Association between chronic asymptomatic pancreatic hyperenzymemia and pancreatic ductal anomalies: a magnetic resonance cholangiopancreatography study

  • Wataru GonoiEmail author
  • Takana Yamakawa Hayashi
  • Naoto Hayashi
  • Osamu Abe



Elucidating the association between pancreatic ductal anomalies and chronic asymptomatic pancreatic hyperenzymemia using magnetic resonance cholangiopancreatography.


We conducted a single-center, retrospective, case–control study. The healthy community group comprised 554 subjects who participated in a paid, whole-body health checkup program. The patient group comprised 14 subjects with idiopathic pancreatic hyperamylasemia or hyperlipasemia. All subjects underwent magnetic resonance cholangiopancreatography. The clinical features and incidence rates of pancreatic ductal anomalies were then compared between the groups.


Compared to the healthy community group, the patient group was significantly more likely to be ≥ age 65 (71.4% of patient group vs. 22.1% of healthy community group), have a history of diabetes mellitus (21.4% vs. 5.4%) or hypertension (35.7% vs. 11.4%), and to have pancreas divisum (21.4% vs. 2.7%), meandering main pancreatic duct (21.4% vs. 4.1%), Wirsungocele (14.3% vs. 1.1%), or dilated main pancreatic duct (14.3% vs. 2.3%). Multivariate analysis found that age ≥ 65 (odds ratio 8.76), presence of pancreas divisum (odds ratio 13.2), meandering main pancreatic duct (odds ratio 8.95), and Wirsungocele (odds ratio 17.6) were independent factors significantly associated with chronic asymptomatic pancreatic hyperenzymemia.


Pancreas divisum, meandering main pancreatic duct, and Wirsungocele were independently associated with chronic asymptomatic pancreatic hyperenzymemia.


Amylase Lipase Magnetic resonance imaging Pancreatitis 



This work was supported by JSPS KAKENHI Grant Number JP25870148.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.

Ethical approval

Our Institutional Review Board approved this STROBE-compliant single-center retrospective case–control study.

Informed consent

Our Institutional Review Board waived informed consent for this STROBE-compliant single-center retrospective case–control study.

STROBE statement

We confirm that this study is STROBE-compliant.


  1. 1.
    Gullo L (1996) Chronic nonpathological hyperamylasemia of pancreatic origin. Gastroenterology 110 (6):1905-1908CrossRefGoogle Scholar
  2. 2.
    Donati F, Boraschi P, Gigoni R, Salemi S, Faggioni L, Bertucci C, Cecchi C, Bartolozzi C, Falaschi F (2010) Secretin-stimulated MR cholangio-pancreatography in the evaluation of asymptomatic patients with non-specific pancreatic hyperenzymemia. Eur J Radiol 75 (2):e38-44. CrossRefGoogle Scholar
  3. 3.
    Mortele KJ, Wiesner W, Zou KH, Ros PR, Silverman SG (2004) Asymptomatic nonspecific serum hyperamylasemia and hyperlipasemia: spectrum of MRCP findings and clinical implications. Abdom Imaging 29 (1):109-114. Google Scholar
  4. 4.
    Liao Z, Gao R, Wang W, Ye Z, Lai XW, Wang XT, Hu LH, Li ZS (2009) A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy 41 (5):439-444. CrossRefGoogle Scholar
  5. 5.
    Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, Maeda E, Yoshikawa T, Tada M, Uno K, Ohtsu H, Koike K, Ohtomo K (2011) Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut 60 (8):1103-1108. CrossRefGoogle Scholar
  6. 6.
    Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, Maeda E, Yoshikawa T, Kiryu S, Tada M, Uno K, Ohtsu H, Okura N, Koike K, Ohtomo K (2012) Meandering main pancreatic duct as a relevant factor to the onset of idiopathic recurrent acute pancreatitis. PLoS One 7 (5):e37652. CrossRefGoogle Scholar
  7. 7.
    Vanella G, Arcidiacono PG, Capurso G (2019) Chronic Asymptomatic Pancreatic Hyperenzymemia (CAPH): Meta-analysis of pancreatic findings at second-level imaging. Pancreatology.
  8. 8.
    Lott JA, Lu CJ (1991) Lipase isoforms and amylase isoenzymes: assays and application in the diagnosis of acute pancreatitis. Clin Chem 37 (3):361-368Google Scholar
  9. 9.
    Frulloni L, Patrizi F, Bernardoni L, Cavallini G (2005) Pancreatic hyperenzymemia: clinical significance and diagnostic approach. JOP 6 (6):536-551Google Scholar
  10. 10.
    Abu-Hamda EM, Baron TH (2004) Cystic dilatation of the intraduodenal portion of the duct of Wirsung (Wirsungocele). Gastrointest Endosc 59 (6):745-747CrossRefGoogle Scholar
  11. 11.
    Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, Maeda E, Yoshikawa T, Kiryu S, Tada M, Uno K, Okura N, Koike K, Ohtomo K (2013) Santorinicele without pancreas divisum pathophysiology: initial clinical and radiographic investigations. BMC Gastroenterol 13:62. CrossRefGoogle Scholar
  12. 12.
    Bang S, Suh JH, Park BK, Park SW, Song SY, Chung JB (2006) The relationship of anatomic variation of pancreatic ductal system and pancreaticobiliary diseases. Yonsei Med J 47 (2):243-248CrossRefGoogle Scholar
  13. 13.
    Amodio A, Manfredi R, Katsotourchi AM, Gabbrielli A, Benini L, Mucelli RP, Vantini I, Frulloni L (2012) Prospective evaluation of subjects with chronic asymptomatic pancreatic hyperenzymemia. Am J Gastroenterol 107 (7):1089-1095. CrossRefGoogle Scholar
  14. 14.
    Testoni PA, Mariani A, Curioni S, Giussani A, Masci E (2009) Pancreatic ductal abnormalities documented by secretin-enhanced MRCP in asymptomatic subjects with chronic pancreatic hyperenzymemia. Am J Gastroenterol 104 (7):1780-1786CrossRefGoogle Scholar
  15. 15.
    Gullo L, Lucrezio L, Calculli L, Salizzoni E, Coe M, Migliori M, Casadei R, Costa PL, Nestico V (2009) Magnetic resonance cholangiopancreatography in asymptomatic pancreatic hyperenzymemia. Pancreas 38 (4):396-400. CrossRefGoogle Scholar
  16. 16.
    Warshaw AL, Simeone JF, Schapiro RH, Flavin-Warshaw B (1990) Evaluation and treatment of the dominant dorsal duct syndrome (pancreas divisum redefined). Am J Surg 159 (1):59-64CrossRefGoogle Scholar
  17. 17.
    Soto JA, Lucey BC, Stuhlfaut JW (2005) Pancreas divisum: depiction with multi-detector row CT. Radiology 235 (2):503-508. CrossRefGoogle Scholar
  18. 18.
    Bertin C, Pelletier AL, Vullierme MP, Bienvenu T, Rebours V, Hentic O, Maire F, Hammel P, Vilgrain V, Ruszniewski P, Levy P (2012) Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations. Am J Gastroenterol 107 (2):311-317. CrossRefGoogle Scholar
  19. 19.
    Tabary O, Zahm JM, Hinnrasky J, Couetil JP, Cornillet P, Guenounou M, Gaillard D, Puchelle E, Jacquot J (1998) Selective up-regulation of chemokine IL-8 expression in cystic fibrosis bronchial gland cells in vivo and in vitro. Am J Pathol 153 (3):921-930. CrossRefGoogle Scholar
  20. 20.
    DiMagno MJ, Dimagno EP (2012) Pancreas divisum does not cause pancreatitis, but associates with CFTR mutations. Am J Gastroenterol 107 (2):318-320. CrossRefGoogle Scholar
  21. 21.
    Gullo L, Mantovani V, Manca M, Migliori M, Bastagli L, Pezzilli R (2005) Mutations of the CFTR gene in idiopathic pancreatic hyperenzymemia. Pancreas 31 (4):350-352CrossRefGoogle Scholar
  22. 22.
    Hayashi TY, Gonoi W, Yoshikawa T, Hayashi N, Ohtomo K (2016) Ansa pancreatica as a predisposing factor for recurrent acute pancreatitis. World J Gastroenterol 22 (40):8940-8948. CrossRefGoogle Scholar
  23. 23.
    Coelho DE, Ardengh JC, Lima-Filho ER, Coelho JF (2011) Different clinical aspects of Wirsungocele: case series of three patients and review of literature. Acta Gastroenterol Latinoam 41 (3):230-233Google Scholar
  24. 24.
    Gonoi W, Akahane M, Tada M, Ohtomo K (2013) False pancreas divisum: a complication of post-endoscopic retrograde pancreatography pancreatitis. Jpn J Radiol 31 (2):148-151. CrossRefGoogle Scholar
  25. 25.
    Frulloni L, Amodio A (2017) Endoscopic ultrasonography in chronic asymptomatic pancreatic hyperenzymemia: The more we see, the less we know. Dig Liver Dis 49 (2):232-233. CrossRefGoogle Scholar
  26. 26.
    Antonini F, Belfiori V, Pagano N, Buscarini E, De Minicis S, Lo Cascio M, Marraccini B, Piergallini S, Rossetti P, Andrenacci E, Macarri G, Pezzilli R (2017) Endoscopic ultrasonography may select subjects having asymptomatic chronic pancreatic hyperenzymemia who require a stricter follow-up. Pancreas 46 (4):524–527. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Radiology, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Computational Diagnostic Radiology and Preventive MedicineThe University of TokyoTokyoJapan

Personalised recommendations