Early Chronic Pancreatitis Findings by Endoscopic Ultrasonography (EUS) in Asymptomatic Patients with Pancreas Divisum

<b>Background/Objectives:</b> Pancreas divisum (PD) is a congenital malformation associated with chronic and recurrent acute pancreatitis. Although PD often presents asymptomatically, the extent to which early chronic pancreatitis (ECP) changes occur in asymptomatic patients with PD remains unclear. This study aimed to evaluate endoscopic ultrasonography (EUS) findings indicative of ECP in asymptomatic patients with PD and investigate the relationship between these findings and background factors, such as age, sex, main pancreatic duct diameter, and alcohol intake. <b>Methods:</b> We retrospectively analyzed 17 asymptomatic patients diagnosed with PD at the Showa University Fujigaoka Hospital between January 2016 and May 2024. EUS was used to assess the pancreatic parenchyma and ductal features, and the findings were classified according to the Rosemont Classification (RC) and the Japan Pancreas Society (JPS) 2019 criteria for ECP (JDCECP2019). Statistical analyses were performed to examine the association between EUS findings and patient background factors. <b>Results:</b> EUS findings of ECP were observed in 8 of 17 asymptomatic patients with PD (47%) according to both the RC and the JDCECP2019 criteria. Hyperechoic foci without shadowing or strands were the most common findings, present in 82% of the patients. No significant associations were found between EUS findings and the background factors of age, sex, main pancreatic duct diameter, or alcohol intake. <b>Conclusions:</b> A considerable proportion of asymptomatic patients with PD exhibited EUS findings suggestive of early chronic pancreatitis. These findings indicate that early changes in chronic pancreatitis may be accompanied by asymptomatic PD.