Clinical Study of Chronic Pancreatitis with Focal Irregular Narrowing of the Main Pancreatic Duct and Mass Formation: Comparison with Chronic Pancreatitis Showing Diffuse Irregular Narrowing of the Main Pancreatic Duct

Pancreas ◽  
2002 ◽  
Vol 25 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Tokio Wakabayashi ◽  
Yukimitsu Kawaura ◽  
Yoshitake Satomura ◽  
Tomoharu Fujii ◽  
Yoshiharu Motoo ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Clinical Study ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Mass Formation

scholarly journals Defining the endoscopic ultrasound features of chronic pancreatitis in Asians: a multicenter validation study

Endoscopy ◽  
2020 ◽  
Author(s):  
Calvin Jianyi Koh ◽  
Sundeep Lakhtakia ◽  
Mitsuhiro Kida ◽  
Cosmas Rinaldi A. Lesmana ◽  
Tiing Leong Ang ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Main Pancreatic Duct ◽  
Cross Sectional Study ◽  
Cancer Surveillance ◽  
Receiver Operating Curve ◽  
Cross Sectional ◽  
Multicenter Prospective Study ◽  
Ultrasound Features

Background Although endoscopic ultrasound (EUS) features and criteria have been described in chronic pancreatitis, challenges remain with interoperator variability and ease of adoption. The aim of this study was to define and validate the EUS features of chronic pancreatitis in a multicenter prospective study in Asia. Method The study was divided into two parts: the first part was conducted to derive the EUS features of chronic pancreatitis with adequate interoperator agreement; the second was to prospectively evaluate these features in a multicenter cross-sectional study and determine the optimal combination of features for the diagnosis of chronic pancreatitis. Prospectively enrolled cases had standard internationally validated radiologic or histologic features of chronic pancreatitis, and controls were patients without chronic pancreatitis who underwent EUS examination. Results The top six EUS features that had good interobserver agreement (mean kappa 0.73, range 0.60 – 0.90) were selected to be further evaluated in part II of the study. These included: hyperechoic foci with shadowing, lobularity with honeycombing, cysts, dilated main pancreatic duct, dilated side branches, and calculi in the main pancreatic duct. A total of 284 subjects (132 cases, 152 controls) were enrolled from 12 centers in Asia. All six features had high accuracy ranging from 63.3 % to 89.1 %. Two or more of these six EUS features accurately defined chronic pancreatitis (sensitivity 94.7 %, specificity 98.0 %), with an area under the receiver operating curve of 0.986. Conclusion This multicenter Asian study characterized and defined the EUS features of chronic pancreatitis. This provides a useful tool in clinical practice and further research in pancreatic cancer surveillance.

scholarly journals Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

2019 ◽  
Vol 36 (04) ◽  
pp. 279-285
Author(s):  
Mythraeyee Prasad ◽  
Sipra Rout ◽  
Tharani Putta ◽  
Reuben Thomas Kurien ◽  
Sudipta Dhar Chowdhury ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Magnetic Resonance ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Radiological Study ◽  
Ductal System ◽  
Type Iii ◽  
Ansa Pancreatica

Abstract Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In the cadaveric study, the main pancreatic duct was single with a straight course in 46.67% of the adult specimens, and in the MRCP study, the main pancreatic duct showed a descending course in 77.66% of the cases. The most common pattern was type III in both the cadaveric (80%) and radiological (55.33%) studies, and the accessory duct was absent on the MRCP in all type-III cases, while it ended blindly in the cadaveric specimens. Ansa pancreatica (type V) was observed in 1 adult specimen (6.7%), but not in the radiological study. Pancreas divisum (type IV) was observed in the 8 cases (7.76%) cases in the radiological study. Conclusion Knowledge of the anatomical variants of the pancreatic ductal system may be helpful for the radiologists during diagnostic and therapeutic interventional procedures.

Management of Chronic Pancreatitis

2016 ◽  
Author(s):  
Darwin L. Conwell ◽  
Veeral M. Oza
Keyword(s):  
Chronic Pancreatitis ◽  
Ct Scan ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Clinical Course ◽  
Islet Cells ◽  
Pain Mechanisms ◽  
Computed Tomographic ◽  
Future Challenges ◽  
Criteria For Diagnosis

Chronic pancreatitis (CP) is a syndrome that is characterized by inflammation, irreversible fibrosis, and loss of acinar and islet cells. It has also been described as an “enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment.” This review describes the epidemiology, diagnosis, diagnostic challenges, differential diagnosis, treatment, complications, and clinical course and prognosis of CP, as well as future challenges. Figures show a computed tomographic (CT) scan of calcific CP, a secretin-enhanced magnetic resonance cholangiopancreatogram showing a dilated and tortuous main pancreatic duct, a CT scan of a large chronic pseudocyst compressing the stomach and pancreas, an endoscopic ultrasound (EUS) image of CP, a retrograde pancreatogram showing a dilated main pancreatic duct with stones and “blunted” side branches, sources of pain in CP, neuropathic pain mechanisms in CP, and an algorithm summarizing treatment of pain in CP. Tables list the TIGAR-O etiologic classification of CP, standard criteria for diagnosis of CP by EUS, Cambridge endoscopic retrograde cholangiopancreatography grading for CP, and a stepwise radiographic and endoscopic diagnostic approach to patients with suspected CP. Key words: bile duct obstruction, chronic pancreatitis, pancreatic calcifications, TIGAR-O system This review contains 8 highly rendered figures, 4 tables, and 54 references.

1111 Modified Eus-Guided Rendezvous Drainage of an Obstructed Non-Dilated Main Pancreatic Duct (MPD) Due to Chronic Pancreatitis

2017 ◽  
Vol 85 (5) ◽  
pp. AB144
Author(s):  
Amol Bapaye ◽  
Mahesh Mahadik ◽  
Nachiket Dubale ◽  
Siva Sankar Reddy Gangireddy
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct

Efficacy of s-type stents for the treatment of the main pancreatic duct stricture in patients with chronic pancreatitis

2006 ◽  
Vol 41 (6) ◽  
pp. 744-750 ◽  
Author(s):  
Takeshi Ishihara ◽  
Taketo Yamaguchi ◽  
Katsushi Seza ◽  
Hiroshi Tadenuma ◽  
Hiromitsu Saisho
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Duct Stricture ◽  
Duct Stricture

Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct

2005 ◽  
Vol 61 (4) ◽  
pp. 576-581 ◽  
Author(s):  
Armando Gabbrielli ◽  
Monica Pandolfi ◽  
Massimiliano Mutignani ◽  
Cristiano Spada ◽  
Vincenzo Perri ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Endoscopic Drainage

scholarly journals Criteria for the Selection of Diagnostic Signs of Chronic Pancreatitis with Obstruction of the Main Pancreatic Duct

2020 ◽  
Vol 13 (2) ◽  
pp. 76-85
Author(s):  
Alexander R Propp ◽  
Evgeny Nikolaevich Degovtsov
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Structural Changes ◽  
Early Stage ◽  
Pancreatic Head ◽  
Diagnostic Methods ◽  
Entire Length ◽  
Diagnostic Signs ◽  
Selection Of

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patients intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

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