## 3 Results
* Based on the 34 major clinical studies summarized in Table 1, the following 10 key points summarize our review's findings:
* PD is the most common congenital anatomic variant of the pancreas. It occurs in approximately 7-10% of individuals. It is often asymptomatic but is thought to be a cause of recurrent pancreatitis in some patients. * EUS is a valuable tool for diagnosing pancreas divisum, a common congenital anomaly of the pancreatic duct. Several studies have evaluated its diagnostic yield, demonstrating a sensitivity ranging from 51% to 95% and a high diagnostic accuracy of 97% [40]. MRCP's sensitivity for comparison with EUS in detecting PD has been reported between 44% and 60%. EUS is particularly effective in identifying pancreas divisum structural features, such as the dorsal pancreatic duct draining into the minor papilla without communication with [PERSON]'s duct. This is when the ventral and dorsal ducts fail to fuse during embryogenesis and dominant drainage occurs via the minor papilla (Figure 1). * Comparative effectiveness: ERCP is the gold standard in the diagnosis of pancreas divisum, but it is more invasive than EUS since it is associated with a significant risk of pancreatitis. In comparison with other modalities like magnetic resonance cholangiocarcinoma-rectography (MRCP) and secretin-enhanced MRCP, EUS has been shown to be more reliable than standard MRCP but slightly less accurate than secretin-MRCP. * Factors influencing EUS accuracy: The endosonographer's expertise, anatomical variations, and pancreatic duct visualization techniques significantly affect diagnostic outcomes. Secretin administration during EUS may enhance duct visibility and improve sensitivity to detect pancreas divisum [26]. * Based on these data, EUS is recognized as a critical diagnostic tool, particularly in patients with recurrent idiopathic acute pancreatitis, for whom identifying the pancreatic divisum can lead to targeted treatment [17; 21; 37; 43; 44]. * EUS vs. MRCP/ERCP: a superior diagnostic yield of EUS in detecting pancreas divisum and biliary pathologies has been reported in a prospective study [19]. * EUS as a first-line diagnostic tool was reported as a safer and more precise alternative procedure in comparison to invasive procedures such as ERCP [17; 34; 44; 42; 43; 45; 46; 47; 48; 49; 50; 51; 52; 53; 54; 55; 56; 57; 58; 59; 60; 61; 62; 63; 64; 65; 66; 67; 68; 69; 70; 71; 72; 73; 74; 75; 76  
As clinical guidelines, some authors have proposed EUS's integration into diagnostic algorithms for pancreas divisum [15; 16; 19]. 10. Three endosonographic criteria have been suggested for the diagnosis of pancreas divisum with endoscopic ultrasound: (a) Inability to follow the main pancreatic duct from the major ampulla to the pancreas body; (b) Inability to follow the main PD from the hypoechoic ventral pancreas to the hyperechoic dorsal pancreas [40]; (c) The presence of the Stack sign as a possibility of pancreas divisum. The Stack sign is visualized better by positioning the radial choendoscope (or by linear choendoscope, reverse Stack sign) in the long scope position with the transducer in the duodenal bulb. When the balloon is inflated and advanced snugly into the apex of the bulb, the bile duct (closest to the transducer) and the pancreatic duct can be seen running in parallel through the pancreatic head [26; 41]. Performing EUS, the Stack sign refers to the parallel alignment of three tubular structures seen in the region of the pancreatic head: common bile duct (CBD), ventral pancreatic duct ([PERSON]'s duct), and dorsal pancreatic duct ([PERSON]'s duct). In pancreas divisum (positive Stack sign): the ventral and dorsal pancreatic ducts remain separate and on EUS, three parallel, stacked tubular structures are evident: (a) the CBD (most anterior); (b) the ventral pancreatic duct (Wirsung); (c) the dorsal pancreatic duct (Santorini) (most posterior). This triple-duct alignment is indicative of non-fusion and suggests pancreas divisum.