AIM:To assess the rate of relapses of acute pancreatitis(AP),recurrent AP(RAP)and the evolution of endosonographic signs of chronic pancreatitis(CP)in patients with pancreas divisum(PDiv)and RAP.METHODS:Over a five-year period,patients with PDiv and RAP prospectively enrolled were divided into two groups:(1)those with relapses of AP in the year before enrollment were assigned to have endoscopic therapy(recent RAP group);and(2)those free of recurrences were conservatively managed,unless they relapsed during follow-up(previous RAP group).All patients in both groups entered a follow-up protocol that includedclinical and biochemical evaluation,pancreatic endoscopic ultrasonography(EUS)every year and after every recurrence of AP,at the same time as endoscopic retrograde cholangiopancreatography(ERCP).RESULTS:Twenty-two were treated by ERCP and 14were conservatively managed during a mean follow-up of 4.5±1.2 years.In the recent RAP group in whom dorsal duct drainage was achieved,AP still recurred in11(57.9%)after the first ERCP,in 6 after the second ERCP(31.6%)and in 5 after the third ERCP(26.3%).Overall,endotherapy was successful 73.7%.There were no cases of recurrences in the previous RAP group.EUS signs of CP developed in 57.9%of treated and 64.3%of untreated patients.EUS signs of CP occurred in 42.8%of patients whose ERCPs were successful and in all those in whom it was unsuccessful(P=0.04).There were no significant differences in the rate of AP recurrences after endotherapy and in the prevalence of EUS signs suggesting CP when comparing patients with dilated and non-dilated dorsal pancreatic ducts within each group.CONCLUSION:Patients with PDiv and recent episodes of AP can benefit from endoscopic therapy.Effective endotherapy may reduce the risk of developing EUS signs of CP at a rate similar to that seen in patients of previous RAP group,managed conservatively.However,in a subset of patients,endotherapy,although successful,did not prevent the evolution of endosonographic signs of CP.