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Bezuidenhout AF, Lee KD, Mashar M, Nakhaei M, Phung L, Lee KS, Wei JL, Brook OR, Mortele KJ. Incidentally detected pancreatic duct dilatation on ultrasound and role of MRI. Abdom Radiol (NY) 2025; 50:1711-1719. [PMID: 39365493 DOI: 10.1007/s00261-024-04583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVE The clinical significance of incidentally detected pancreatic duct (PD) dilatation at ultrasound (US) without a visualized underlying cause is unclear. We aimed to assess the role of subsequent MRI (including MRCP) and to identify US imaging and laboratory findings predictive of underlying pancreaticobiliary malignancy at the time of initial US. MATERIALS AND METHODS Patients with incidentally detected PD dilatation at ultrasound from 2011 to 2019 that had an ensuing MRI were included. Based on MRI results patients were divided into three groups: malignant pancreaticobiliary causes, benign causes and idiopathic PD dilatation. Subsequently the diagnostic ability of MRI was assessed. Initial ultrasound findings and laboratory results were compared between groups to identify predictors of underlying pancreaticobiliary pathology. A p-value < .05 was considered statistically significant. RESULTS In 37/59 (63%) patients PD dilatation was confirmed on MRI. MRI demonstrated malignant 7/59 (12%) and benign 10/59 (17%) causes of PD dilatation detected at initial ultrasound. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of MRI to ascertain the cause of PD dilatation was 89%, 100%, 95%, 100% and 97% respectively. Patients with a larger magnitude of PD dilatation, concomitant CBD dilatation and elevated lipase values were more likely to have underlying pancreaticobiliary malignancy (p < 0.05). No patient with initial negative MRI had pancreaticobiliary malignancy on subsequent work-up. CONCLUSION Incidentally detected PD dilatation on ultrasound is an important finding and should prompt referral to MRI. MRI is an accurate, noninvasive method for identifying the underlying cause of PD dilatation in these patients and in excluding pancreaticobiliary malignancy.
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Affiliation(s)
| | - Kristy D Lee
- Beth Israel Deaconess Medical Center, Boston, USA
| | | | | | - Lauren Phung
- Beth Israel Deaconess Medical Center, Boston, USA
| | - Karen S Lee
- Beth Israel Deaconess Medical Center, Boston, USA
| | - Jesse L Wei
- Beth Israel Deaconess Medical Center, Boston, USA
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, USA
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van Veldhuisen CL, Leseman CA, De Rijk FEM, Marques-Antunes J, Ausania F, Belyaev O, Berrevoet F, Boermeester MA, Boggi U, Bouwense SA, Bruno MJ, Busch OR, Conlon KC, Dokmak S, Falconi M, Ghorbani P, Gryspeerdt F, Haen R, Ibrahimli A, Izbicki JR, Krikke C, Kokkola A, Marique L, Mieog JSD, Nappo G, Pavulans J, Plaudis H, Roeyen G, Scognamiglio P, Tamburrino D, Tholfsen T, Toschka M, Uzunoglu FG, van Dieren S, Van Eijck CHJ, van Hooft JE, van Santvoort HC, Verdonk RC, Voermans RP, Waage A, Besselink MG. Surgery for chronic pancreatitis across Europe (ESCOPA): prospective multicentre study. Br J Surg 2025; 112:znaf068. [PMID: 40296656 PMCID: PMC12038157 DOI: 10.1093/bjs/znaf068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/27/2025] [Accepted: 03/07/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Randomized trials have demonstrated the superiority of surgery over endoscopy in patients with symptomatic chronic pancreatitis. However, large international studies quantifying the impact of surgery on chronic pancreatitis are lacking. The aim of this study was to evaluate current practice across Europe regarding indications, surgical techniques, and outcomes of surgery for chronic pancreatitis. METHODS A prospective multicentre study of consecutive patients undergoing surgery for symptomatic chronic pancreatitis from 22 centres in 13 countries from 1 June 2021 to 30 November 2022 was conducted. The outcome of interest in patients with pain as an indication was the Izbicki pain score at 6-month follow-up, with complete pain relief defined as an Izbicki pain score ≤10 and partial pain relief defined as an Izbicki pain score >10, but with a >50% decrease compared with the baseline score. Quality of life was assessed using Pancreatitis Quality of Life Instrument (PANQOLI) and 12-Item Short-Form (SF-12) surveys. Predictors of pain relief were analysed using multivariable analysis. RESULTS Overall, 207 patients underwent surgery (24.6% underwent surgical drainage procedures, 29.5% underwent duodenum-preserving head resections, and 45.9% underwent formal pancreatic resections). Before surgery, 48.8% used opioids and 51.2% had undergone prior endoscopic treatment. Major morbidity occurred in 14.0% and the 90-day mortality rate was 1.4%. Among 113 patients operated on for pain, the median Izbicki pain score decreased from 61.3 to 19.0 at 6 months (P < 0.001). Pain relief was achieved in 72.6% (43 patients reported complete pain relief and 39 patients reported partial pain relief). PANQOLI and SF-12 Physical Component Summary scores improved significantly (P < 0.001). Longer symptom duration (OR 0.95 (95% c.i. 0.90 to 1.00), P = 0.045) and use of opioids before surgery (OR 3.16 (95% c.i. 1.04 to 9.64), P = 0.043) predicted less pain relief. CONCLUSION Surgery for chronic pancreatitis across Europe was performed with low morbidity. Patients reported good pain relief and improvements in quality-of-life scores. Multidisciplinary consultation is recommended for all patients with chronic pancreatitis before undergoing any intervention.
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Affiliation(s)
- Charlotte L van Veldhuisen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Research and Development, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Charlotte A Leseman
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fleur E M De Rijk
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Fabio Ausania
- Department of Hepatic, Pancreatic, Biliary, and Transplant Surgery, Clinic Hospital, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Orlin Belyaev
- Department of Surgery, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Frederik Berrevoet
- General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Stefan A Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kevin C Conlon
- Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France
| | - Massimo Falconi
- Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Filip Gryspeerdt
- General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium
| | - Roel Haen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Jakob R Izbicki
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Christina Krikke
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arto Kokkola
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lancelot Marique
- Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Pancreatic Surgery Unit, Humanitas Clinical and Research Centre, IRCCS, Milan, Italy
| | - Janis Pavulans
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Haralds Plaudis
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Geert Roeyen
- Department of Hepatobiliary Transplantation and Endocrine Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pasquale Scognamiglio
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Domenico Tamburrino
- Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marie Toschka
- Department of Surgery, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Faik G Uzunoglu
- Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Rogier P Voermans
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Asghar A, Narayan RK, Pushpa NB, Patra A, Ravi KS, Tubbs RS. Exploring the variations of the pancreatic ductal system: a systematic review and meta-analysis of observational studies. Anat Cell Biol 2024; 57:31-44. [PMID: 38351473 PMCID: PMC10968189 DOI: 10.5115/acb.23.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/09/2023] [Accepted: 12/24/2023] [Indexed: 03/23/2024] Open
Abstract
The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS, addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar databases were searched to identify publications relevant to this review. R studio with meta-package was used for data extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type 3 variants and "descending" subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or pseudocysts formation.
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Affiliation(s)
- Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Ravi Kant Narayan
- Department of Anatomy, ESIC Medical College & Hospital, Patna, India
| | | | - Apurba Patra
- All India Institute of Medical Sciences, Bathinda, India
| | | | - R. Shane Tubbs
- Tulane University School of Medicine, New Orleans, LA, USA
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Case JB, Adin C, Chiquitha C, Gilor C. Laparoscopic partial pancreatectomy of the left limb using a harmonic scalpel in nine cats. Vet Surg 2024; 53:350-356. [PMID: 38037261 DOI: 10.1111/vsu.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To describe a laparoscopic technique and outcome for partial pancreatectomy in cats. STUDY DESIGN Prospective cohort study. ANIMALS Nine cats. METHODS Laparoscopic pancreatectomy was performed using a single incision laparoscopic surgery port and an additional 5.5 mm port. The left pancreatic limb was dissected, sealed and divided at the level of the splenic vein insertion to the portal vein using a harmonic device. Surgical time and complications were recorded. The weight and length of the resected pancreatic limb was recorded. Pre- and postoperative trypsin-like immunoreactivity (TLI), pancreatic lipase immunoreactivity (PLI), and hemoglobin A1C were documented. RESULTS Laparoscopic partial pancreatectomy was performed successfully in all cats. One grade 1 intraoperative complication occurred (1/9; 11%) resulting in minor hemorrhage from a caudal splenic vein branch. A grade 2 postoperative complication occurred within 3 days after surgery in one cat (1/9; 11%), involving localized, sterile peritonitis in the region of the pancreatic angle. Signs resolved with conservative management. No cats exhibited signs of pancreatitis postoperatively. Long-term, mean TLI decreased by 37% ± 38% (p = .03) following partial pancreatectomy, while PLI and A1C were unchanged. All cats were alive and clinically well at last follow-up 250 to 446 days following surgery. CONCLUSIONS Laparoscopic partial pancreatectomy using a harmonic device is effective in cats, and offers a minimally-invasive alternative to open surgical pancreatectomy techniques. Laparoscopic pancreatectomy of the left limb results in adequate exocrine and endocrine function in the long-term.
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Affiliation(s)
- J Brad Case
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Christopher Adin
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Crews Chiquitha
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Chen Gilor
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
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Gu Z, Du Y, Wang P, Zheng X, He J, Wang C, Zhang J. Development and validation of a novel nomogram to predict postoperative pancreatic fistula after pancreatoduodenectomy using lasso-logistic regression: an international multi-institutional observational study. Int J Surg 2023; 109:4027-4040. [PMID: 37678279 PMCID: PMC10720876 DOI: 10.1097/js9.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Existing prediction models for clinically relevant postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) lack discriminatory power or are too complex. This study aimed to develop a simple nomogram that could accurately predict clinically relevant POPF after PD. METHODS A high-volume, multicenter cohort of patients who underwent PD from the American College of Surgeons-National Surgical Quality Improvement Program database in the United States during 2014-2017 was used as the model training cohort ( n =3609), and patients who underwent PD from the Pancreatic Center of the National Cancer Center Hospital in China during 2014-2019 were used as the external validation cohort ( n =1347). The study used lasso penalized regression to screen large-scale variables, then logistic regression was performed to screen the variables and build a model. Finally, a prediction nomogram for clinically relevant POPF was established based on the logistic model, and polynomial equations were extracted. The performance of the nomogram was evaluated by receiver operating characteristic curve, calibration curve, and decision curve analysis. RESULTS In the training and validation cohorts, there were 16.7% (601/3609) and 16.6% (224/1347) of patients who developed clinically relevant POPF, respectively. After screening using lasso and logistic regression, only six predictors were independently associated with clinically relevant POPF, including two preoperative indicators (weight and pancreatic duct size), one intraoperative indicator (pancreatic texture), and three postoperative indicators (deep surgical site infection, delayed gastric emptying, and pathology). The prediction of the new nomogram was accurate, with an area under the curve of 0.855 (95% CI: 0.702-0.853) in the external validation cohort, and the predictive performance was superior to three previously proposed POPF risk score models (all P <0.001, likelihood ratio test). CONCLUSIONS A reliable lasso-logistic method was applied to establish a novel nomogram based on six readily available indicators, achieving a sustained, dynamic, and precise POPF prediction for PD patients. With a limited number of variables and easy clinical application, this new model will enable surgeons to proactively predict, identify, and manage pancreatic fistulas to obtain better outcomes from this daunting postoperative complication.
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Affiliation(s)
- Zongting Gu
- Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang
| | - Yongxing Du
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Peng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Xiaohao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jin He
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
- Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jianwei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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Tornel-Avelar AI, Velarde Ruiz-Velasco JA, Pelaez-Luna M. Pancreatic cancer, autoimmune or chronic pancreatitis, beyond tissue diagnosis: Collateral imaging and clinical characteristics may differentiate them. World J Gastrointest Oncol 2023; 15:925-942. [PMID: 37389107 PMCID: PMC10302998 DOI: 10.4251/wjgo.v15.i6.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 06/14/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related death. Often, the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses, such as autoimmune pancreatitis (AIP) and mass-forming chronic pancreatitis (MFCP), making its diagnosis challenging. Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications. Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses; however, the diagnostic accuracy is imperfect. Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis. It is not unusual that after a thorough diagnostic evaluation, the clinician is confronted with a pancreatic mass with uncertain diagnosis. In those cases, a re-evaluation must be entertained, preferably by an experienced multispecialty team including radiologists, pathologists, gastroenterologists, and surgeons, looking for disease-specific clinical, imaging, and histological hallmarks or collateral evidence that could favor a specific diagnosis. Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP, PDAC, and MFCP and to highlight those disease-specific clinical, radiological, serological, and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.
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Affiliation(s)
- Ana I Tornel-Avelar
- Department of Gastroenterology, Hospital Civil of Guadalajara “Fray Antonio Alcalde”, Guadalajara 44340, Jalisco, Mexico
| | | | - Mario Pelaez-Luna
- Research Division School of Medicine/Department of Gastroenterology, Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, Tlalpan 14000, Mexico City, Mexico
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7
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Tajikawa T, Aoki K, Fukuzawa H. Investigation of pancreatic juice reflux mechanism in high confluence of pancreaticobiliary ducts and pancreaticobiliary maljunction (Development and validation of a mathematical model for pancreatic and bile juice flow based on fluid mechanics). JOURNAL OF BIORHEOLOGY 2023; 37:44-55. [DOI: 10.17106/jbr.37.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Affiliation(s)
- Tsutomu Tajikawa
- Department of Mechanical Engineering, Faculty of Engineering Science, Kansai University
| | - Keita Aoki
- Graduate School of Science and Engineering, Kansai University
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Japanese Red Cross Society, Himeji Hospital
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Nadella S, Lieb JG. Minimal Change Patients Versus Obvious Chronic Pancreatitis: A Comparison of Classical Secretin Stimulation Testing Results. Pancreas 2022; 51:75-79. [PMID: 35195598 PMCID: PMC8887794 DOI: 10.1097/mpa.0000000000001965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective was to assess if the peak bicarbonate level during secretin stimulation testing (SST) differs between patients with minimal change (or small duct) chronic pancreatitis (CP) versus those with obvious CP (or large duct) versus those without CP. METHODS Two hundred nineteen patient records at the University of Florida who had been referred for SST were analyzed for peak bicarbonate, total volume of juice collected, age, sex, and clinical presentation. RESULTS Fifty-one patients with minimal change CP were identified. Thirty-three patients were felt to have advanced CP, and 135 patients did not have CP by clinical criteria. The peak bicarbonate and total volume of pancreatic juice collected was significantly different (P < 0.001) between all 3 groups by multiple comparison testing. The peak bicarbonate of advanced CP and minimal change groups was less than controls (P < 0.001). There was a significant difference (P < 0.05) on direct testing between peak bicarbonate in advanced CP and minimal change CP. CONCLUSIONS The peak bicarbonate and volume measured during SST differs among patients with minimal change CP, advanced CP and in disease controls. These results could be useful in diagnosing minimal change/early CP.
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Affiliation(s)
- Sandeep Nadella
- From the Cold Spring Harbor Laboratory/Northwell Health, Cold Spring Harbor Laboratory, NY
| | - John G Lieb
- Division of Gastroenterology, Drexel University School of Medicine, Philadelphia, PA
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9
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Fung CI, Bigam DL, Wong CKW, Hurrell C, Bird JR, Brahm GL, Kirkpatrick IDC. Recommendations for the Management of Incidental Pancreatic Findings in Adults by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2021; 73:312-319. [PMID: 34154391 DOI: 10.1177/08465371211021079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2021 Canadian guidelines for the management of pancreatic incidental findings. Topics covered include anatomic variants, fatty atrophy, pancreatic calcifications, ductal ectasia, and management of incidental pancreatic cysts.
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Affiliation(s)
- Christopher I Fung
- Department of Radiology and Diagnostic Imaging, 3158University of Alberta, Edmonton, Alberta, Canada
| | - David L Bigam
- Department of Surgery, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Clarence K W Wong
- Division of Gastroenterology, Department of Medicine, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Jeffery R Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary L Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Morphologic Factors Predict Pain Relief Following Pancreatic Head Resection in Chronic Pancreatitis Description of the Chronic Pancreatitis Pain Relief (CPPR) Score. Ann Surg 2021; 273:800-805. [PMID: 31348039 DOI: 10.1097/sla.0000000000003439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study analyzes the clinicopathologic findings and their impact on outcome of patients so as to identify which patients benefit most from surgical treatment in chronic pancreatitis, especially in regard to pain relief. SUMMARY BACKGROUND DATA The predominant symptom of chronic pancreatitis is chronic pain resulting in reduced quality of life. It is well known that the main reason for development of the disease is abuse of alcohol and nicotine, but only little data on factors influencing outcome are available. METHODS One thousand one hundred forty-six consecutive patients who underwent surgery for chronic pancreatitis were included. Clinicopathologic data, including morphology of the pancreas in preoperative diagnostics and the histopathologic results, were evaluated. A long-term follow-up including Quality of Life and pain scores was performed. Additionally, we describe the novel Chronic Pancreatitis Pain Relief Score (CPPR-Score) as a tool for prediction of pain relief. RESULTS Overall the rate of pain relief was 79.8% after surgery. The presence of an inflammatory mass in the pancreatic head larger than 4 cm (P < 0.001), presence of a dilated main pancreatic duct of over 4 mm (P < 0.001), histopathologically detected severe calcifications (P = 0.001) and severe fibrosis (P < 0.001) as well as ethanol induced disease (P < 0.001) found to be strong independent prognostic factors for pain relief. The CPPR-Score (0-5 points) proved to be a very good predictive score for pain-relief (P < 0.001). CONCLUSIONS The rate of pain relief after surgical treatment in chronic pancreatitis is high and the commonly used procedures can be performed with acceptable morbidity and mortality. The Chronic Pancreatitis Pain Relief Score allows identifying patients who will benefit most from surgery.
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Burrowes DP, Choi HH, Rodgers SK, Fetzer DT, Kamaya A. Utility of ultrasound in acute pancreatitis. Abdom Radiol (NY) 2020; 45:1253-1264. [PMID: 31844915 DOI: 10.1007/s00261-019-02364-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound plays an essential role in the initial evaluation of patients with suspected or confirmed acute pancreatitis. In addition to evaluation of the pancreatic parenchyma, ultrasound is used for assessment of the gallbladder, biliary tree, peripancreatic tissues, and regional vascular structures. While enlarged and edematous pancreas are classic sonographic features of acute pancreatitis, the pancreas may appear sonographically normal in the setting of acute pancreatitis. Nonetheless, sonographic evaluation in this setting is valuable because assessment for etiologic factors such as gallstones or evidence of biliary obstruction are best performed with ultrasound. Complications of pancreatitis such as peripancreatic fluid collections, venous thrombosis, or arterial pseudoaneurysm can be identified with careful and focused ultrasound examination. Knowledge of various scanning techniques can help to mitigate some of the commonly encountered barriers to sonographic visualization of the pancreas and right upper quadrant structures. Ultrasound can also be used for guidance of percutaneous treatment such as drainage of fluid collections or pseudoaneurysm thrombosis. Difficulty in differentiating edematous from necrotizing pancreatitis can be mitigated with the use of contrast-enhanced ultrasound to assess pancreatic parenchymal enhancement.
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Affiliation(s)
- David P Burrowes
- University of Calgary Cumming School of Medicine, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| | - Hailey H Choi
- UCSF, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA, 19141, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - David T Fetzer
- UT Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd E6-230, Dallas, TX, 75390-9316, USA
| | - Aya Kamaya
- Stanford University Department of Radiology, 300 Pasteur Drive H1307, Stanford, CA, 94305, USA
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12
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Vasen HFA, Boekestijn B, Ibrahim IS, Inderson A, Bonsing BA, de Vos Tot Nederveen Cappel WH, Feshtali S, Wasser MN. Dilatation of the main pancreatic duct as first manifestation of small pancreatic ductal adenocarcinomas detected in a hereditary pancreatic cancer surveillance program. HPB (Oxford) 2019; 21:1371-1375. [PMID: 30910317 DOI: 10.1016/j.hpb.2019.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND MRI surveillance in a cohort of CDKN2A-p16-Leiden mutation carriers with a 20% lifetime risk of PDAC led to increased resection rates and improved survival. Patients with screen-detected PDAC were evaluated for main pancreatic duct (MPD) abnormalities in this retrospective review. METHODS Since 2000 annual MRI and optional EUS was performed in mutation carriers. Data of patients with screen-detected PDAC was collected on gender, age at diagnosis, site of tumor, size, outcome of surgery, pathology findings and survival. All MRIs were re-evaluated for MPD abnormalities. RESULTS 23 PDAC were detected in 22 (10%) of 217 mutation carriers, 10 (45%) males and 12 (55%) females. The mean age at diagnosis was 59.8 years (range 39.2-74.3 years). Revision of the MRI/MRCP revealed a lesion and dilatation of the MPD in 8 of the 22 patients. In 5 of 7 patients with PDAC detected during follow-up, the previous MRI showed MPD dilatation without evidence of tumor. The mean size of PDAC was 12.3 mm (range 5-19 mm). All tumors were resectable. CONCLUSION MPD dilation is common in patients with screen-detected PDAC. Abnormalities on MRI during surveillance of high-risk individuals requires intense follow-up or prompt treatment, as early treatment results in a better prognosis.
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Affiliation(s)
- Hans F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Isaura S Ibrahim
- Department of Gastroenterology & Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology & Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Shirin Feshtali
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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13
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Tirkes T, Shah ZK, Takahashi N, Grajo JR, Chang ST, Venkatesh SK, Conwell DL, Fogel EL, Park W, Topazian M, Yadav D, Dasyam AK, For the Consortium for the Study of Chronic Pancreatitis, Diabetes, and
Pancreatic Cancer. Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology 2019; 290:207-215. [PMID: 30325281 PMCID: PMC6314625 DOI: 10.1148/radiol.2018181353] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Chronic pancreatitis is an inflammatory condition of the pancreas with clinical manifestations ranging from abdominal pain, acute pancreatitis, exocrine and/or endocrine dysfunction, and pancreatic cancer. There is a need for longitudinal studies in well-phenotyped patients to ascertain the utility of cross-sectional imaging findings of chronic pancreatitis for diagnosis and assessment of disease severity. CT and MR cholangiopancreatography are the most common cross-sectional imaging studies performed for the evaluation of chronic pancreatitis. Currently, there are no universal reporting standards for chronic pancreatitis. Several features of chronic pancreatitis are applied clinically, such as calcifications, parenchymal T1 signal changes, focal or diffuse gland atrophy, or irregular contour of the gland. Such findings have not been incorporated into standardized diagnostic criteria. There is also lack of consensus on quantification of disease severity in chronic pancreatitis, other than by using ductal features alone as described in the Cambridge classification. The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was established by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute in 2015 to undertake collaborative studies on chronic pancreatitis, diabetes mellitus, and pancreatic adenocarcinoma. CPDPC investigators from the Adult Chronic Pancreatitis Working Group were tasked with development of a new consensus approach to reporting features of chronic pancreatitis aimed to standardize diagnosis and assessment of disease severity for clinical trials. This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Megibow in this issue.
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Affiliation(s)
- Temel Tirkes
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Zarine K. Shah
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Naoki Takahashi
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Joseph R. Grajo
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Stephanie T. Chang
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Darwin L. Conwell
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Evan L. Fogel
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Walter Park
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Mark Topazian
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Dhiraj Yadav
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - Anil K. Dasyam
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
| | - For the Consortium for the Study of Chronic Pancreatitis, Diabetes, and
Pancreatic Cancer
- From the Department of Radiology and Imaging Sciences (T.T.) and
Department of Medicine, Division of Gastroenterology (E.L.F.), Indiana
University School of Medicine, 550 N University Blvd, Suite 0663, Indianapolis,
Ind 46202; Department of Radiology (Z.K.S.) and Department of Medicine, Division
of Gastroenterology, Hepatology & Nutrition (D.L.C.), Ohio State University
Wexner Medical Center, Columbus, Ohio; Department of Radiology (N.T., S.K.V.)
and Department of Medicine, Division of Gastroenterology and Hepatology (M.T.),
Mayo Clinic, Rochester, Minn; Department of Radiology, University of Florida
College of Medicine, Gainesville, Fla (J.R.G.); Department of Radiology and
Division of Body MRI, Stanford University School of Medicine, Stanford, Calif
(S.T.C.); Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University Medical Center, Stanford, Calif (W.P.); Department of
Medicine, Division of Gastroenterology, Hepatology & Nutrition, University
of Pittsburgh School of Medicine, Pittsburgh, Pa (D.Y.); Department of
Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
(A.K.D.)
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14
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Goudra BG, Singh PM. Anesthesia for ERCP. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Scott SJ, Adams MS, Salgaonkar V, Sommer FG, Diederich CJ. Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas. J Ther Ultrasound 2017; 5:10. [PMID: 28469915 PMCID: PMC5414307 DOI: 10.1186/s40349-017-0090-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background The goal of this study was to theoretically investigate the feasibility of intraductal and transgastric approaches to ultrasound-based thermal therapy of pancreatic tumors, and to evaluate possible treatment strategies. Methods This study considered ultrasound applicators with 1.2 mm outer diameter tubular transducers, which are inserted into the tissue to be treated by an endoscopic approach, either via insertion through the gastric wall (transgastric) or within the pancreatic duct lumen (intraductal). 8 patient-specific, 3D, transient, biothermal and acoustic finite element models were generated to model hyperthermia (n = 2) and ablation (n = 6), using sectored (210°–270°, n = 4) and 360° (n = 4) transducers for treatment of 3.3–17.0 cm3 tumors in the head (n = 5), body (n = 2), and tail (n = 1) of the pancreas. A parametric study was performed to determine appropriate treatment parameters as a function of tissue attenuation, blood perfusion rates, and distance to sensitive anatomy. Results Parametric studies indicated that pancreatic tumors up to 2.5 or 2.7 cm diameter can be ablated within 10 min with the transgastric and intraductal approaches, respectively. Patient-specific simulations demonstrated that 67.1–83.3% of the volumes of four sample 3.3–11.4 cm3 tumors could be ablated within 3–10 min using transgastric or intraductal approaches. 55.3–60.0% of the volume of a large 17.0 cm3 tumor could be ablated using multiple applicator positions within 20–30 min with either transgastric or intraductal approaches. 89.9–94.7% of the volume of two 4.4–11.4 cm3 tumors could be treated with intraductal hyperthermia. Sectored applicators are effective in directing acoustic output away from and preserving sensitive structures. When acoustic energy is directed towards sensitive structures, applicators should be placed at least 13.9–14.8 mm from major vessels like the aorta, 9.4–12.0 mm from other vessels, depending on the vessel size and flow rate, and 14 mm from the duodenum. Conclusions This study demonstrated the feasibility of generating shaped or conformal ablative or hyperthermic temperature distributions within pancreatic tumors using transgastric or intraductal ultrasound.
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Affiliation(s)
- Serena J Scott
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA
| | - Matthew S Adams
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA.,UC Berkeley - UC San Francisco Graduate Program in Bioengineering, California, USA
| | - Vasant Salgaonkar
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA
| | - F Graham Sommer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Chris J Diederich
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA.,UC Berkeley - UC San Francisco Graduate Program in Bioengineering, California, USA
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16
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Sinha A, Patel YA, Cruise M, Matsukuma K, Zaheer A, Afghani E, Yadav D, Makary MA, Hirose K, Andersen DK, Singh VK. Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure. J Gastrointest Surg 2016; 20:734-40. [PMID: 26813017 DOI: 10.1007/s11605-016-3081-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 01/12/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. METHODS All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. RESULTS A total of 60 patients (age 51.6 years, 53% males) were included in our study, of whom 42 (70%) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62%) patients with toxic etiology, 36 (60%) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p < 0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95% CI 1.3, 24.5, p = 0.02). CONCLUSION Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.
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Affiliation(s)
- Amitasha Sinha
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yuval A Patel
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael Cruise
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Karen Matsukuma
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elham Afghani
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kenzo Hirose
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dana K Andersen
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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17
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Sharma M, Rai P, Rameshbabu CS, Arya S. Imaging of the pancreatic duct by linear endoscopic ultrasound. Endosc Ultrasound 2015; 4:198-207. [PMID: 26374577 PMCID: PMC4568631 DOI: 10.4103/2303-9027.162997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/14/2014] [Indexed: 12/15/2022] Open
Abstract
The current gold standard investigation for anatomic exploration of the pancreatic duct (PD) is endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography is a noninvasive method for exploration of the PD. A comprehensive evaluation of the course of PD and its branches has not been described by endoscopic ultrasound (EUS). In this article, we describe the techniques of imaging of PD using linear EUS.
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | | | - Shalini Arya
- Department of Medicine, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
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18
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Chantarojanasiri T, Hirooka Y, Ratanachu-Ek T, Kawashima H, Ohno E, Goto H. Evolution of pancreas in aging: degenerative variation or early changes of disease? J Med Ultrason (2001) 2015; 42:177-183. [PMID: 26576570 DOI: 10.1007/s10396-014-0576-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/19/2014] [Indexed: 02/07/2023]
Abstract
Pancreatic changes in aging have been described for many decades. They involve not only pancreatic parenchyma but also pancreatic ductal, microscopic, and exocrine functional changes. There have been many studies of these changes based on pathology and various imaging modalities, as well as functional studies. The pancreatic volume was found to decrease with advancing age, with a higher incidence of pancreatic steatosis, as demonstrated in autopsy and imaging studies. The pancreatic ductal structure has been described with wide ranges of normal variation, but many studies have shown a tendency toward enlargement with advancing age. By endoscopic ultrasound imaging, the aging pancreas may exhibit abnormal findings similar to chronic pancreatitis. Microscopically, there has been evidence of patchy lobular fibrosis and papillary hyperplasia and demonstrable k-ras mutation in both normal and dysplastic ductal mucosa. The evidence of pancreatic exocrine insufficiency has yielded conflicting results, but most studies have shown a tendency toward decreased pancreatic exocrine function in the elderly. Differentiating pancreatic change in the elderly from early chronic pancreatitis may be difficult as there are limited studies to compare these two conditions in terms of structural and functional changes.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan.
| | | | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, 466-8550, Japan
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19
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Sell NM, Pucci MJ, Gabale S, Leiby BE, Rosato EL, Winter JM, Yeo CJ, Lavu H. The influence of transection site on the development of pancreatic fistula in patients undergoing distal pancreatectomy: A review of 294 consecutive cases. Surgery 2015; 157:1080-7. [PMID: 25791028 DOI: 10.1016/j.surg.2015.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/15/2014] [Accepted: 01/11/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pancreatic fistula (PF) is a significant cause of morbidity in patients undergoing distal pancreatectomy (DP), with an incidence of 15-40%. It remains unclear if the location of pancreatic transection affects the rate of PF occurrence. This study examines the correlation between the transection site of the pancreas during DP and the incidence of PF. METHODS All cases of DP from October 2005 to January 2012 were reviewed retrospectively from an institutional review board-approved database at the Thomas Jefferson University Hospital. Patient demographics and perioperative outcomes were analyzed. The pancreatic transection location was determined by review of operative reports, and then dichotomized into 2 groups: neck/body or tail. PF were graded following the International Study Group on Pancreatic Fistula guidelines. RESULTS During the study period, 294 DP were performed with 244 pancreas transections at the neck/body and 50 at the tail. Of the 294 patients, 52 (17.7%) developed a postoperative PF. The incidence of PF after transection at the tail of the pancreas was higher (28%) when compared with transection at the neck/body (15.6%; P = .04). When stratified by PF grade, grade A PF occurred more commonly when transection of the gland was at the tail (22% tail vs 8.2% neck/body; P = .007); however, no difference was found for grade B/C PF (6% tail vs 7.4% neck/body; P = 1). CONCLUSION Our data suggest that PF occurs more often when the tail is transected during DP, although the majority are low grade and of minimal clinical significance. More severe PF occurred equally between the transection sites.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Michael J Pucci
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Salil Gabale
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E Leiby
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ernest L Rosato
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Jordan M Winter
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Harish Lavu
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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20
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Sinha A, Singh VK, Cruise M, Afghani E, Matsukuma K, Ali S, Andersen DK, Makary MA, Raman SP, Fishman EK, Zaheer A. Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery. Eur Radiol 2014; 25:1339-46. [DOI: 10.1007/s00330-014-3526-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/28/2014] [Accepted: 11/19/2014] [Indexed: 12/22/2022]
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21
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Cooper MA, Makary MA, Ng J, Cui Y, Singh VK, Matsukuma K, Andersen DK. Extent of pancreatic fibrosis as a determinant of symptom resolution after the Frey procedure: a clinico-pathologic analysis. J Gastrointest Surg 2013; 17:682-7. [PMID: 23345052 DOI: 10.1007/s11605-012-2110-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/21/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the association of histopathologic features of chronic pancreatitis and pain relief after the Frey procedure. DESIGN We retrospectively analyzed 35 patients who underwent the Frey procedure for chronic pancreatitis over a 5-year period (November 2005 to February 2011). SETTING Thirty-five patients with varied etiologies of chronic pancreatitis and persistent symptoms were referred to a multi-disciplinary pancreatitis clinic where a consensus decision to recommend surgery was established. The Frey procedure was then performed. MAIN OUTCOME MEASURES We compared symptomatic outcomes with the degree of pancreatic fibrosis, duct dilatation, and presence of pancreatic duct stones based on a blinded evaluation of resected pancreatic tissue. RESULTS Symptom resolution was associated with severe or extensive (>75 %) fibrosis and absence of symptom resolution was associated with mild or minimal (<25 %) fibrosis (chi-squared, p value < 0.05). Symptom resolution was associated with pancreatic duct >4 mm and absence of symptom resolution was associated with pancreatic duct ≤4 mm (chi-squared, p value < 0.05). There was no difference in outcomes for patients with and without pancreatic duct stones. CONCLUSION Symptom resolution after the Frey procedure is more likely in the setting of severe or extensive fibrosis due to chronic pancreatitis.
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Affiliation(s)
- Michol A Cooper
- Department of Surgery, Johns Hopkins Hospital, Blalock 655, 600 N. Wolfe St., Baltimore, MD 21231, USA.
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22
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Chandler JE, Lee CM, Babchanik AP, Melville CD, Saunders MD, Seibel EJ. Evaluation of a novel, ultrathin, tip-bending endoscope in a synthetic force-sensing pancreas with comparison to medical guide wires. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2012; 5:1-12. [PMID: 23166452 PMCID: PMC3500967 DOI: 10.2147/mder.s27439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose Direct visualization of pancreatic ductal tissue is critical for early diagnosis of pancreatic diseases and for guiding therapeutic interventions. A novel, ultrathin (5 Fr) scanning fiber endoscope (SFE) with tip-bending capability has been developed specifically to achieve high resolution imaging as a pancreatoscope during endoscopic retrograde cholangiopancreatography (ERCP). This device has potential to dramatically improve both diagnostic and therapeutic capabilities during ERCP by providing direct video feedback and tool guidance to clinicians. Methods Invasiveness of the new tip-bending SFE was evaluated by a performance comparison to ERCP guide wires, which are routinely inserted into the pancreatic duct during ERCP. An in vitro test model with four force sensors embedded in a synthetic pancreas was designed to detect and compare the insertion forces for 0.89 mm and 0.53 mm diameter guide wires as well as the 1.7 mm diameter SFE. Insertions were performed through the working channel of a therapeutic duodenoscope for the two types of guide wires and using a statistically similar direct insertion method for comparison to the SFE. Results Analysis of the forces detected by the sensors showed the smaller diameter 0.53 mm wire produced significantly less average and maximum forces during insertion than the larger diameter 0.89 mm wire. With the use of tip-bending and optical visualization, the 1.7 mm diameter SFE produced significantly less average force during insertion than the 0.89 mm wire at every sensor, despite its larger size. It was further shown that the use of tip-bending with the SFE significantly reduced the forces at all sensors, compared to insertions when tip-bending was not used. Conclusion Combining high quality video imaging with two-axis tip-bending allows a larger diameter guide wire-style device to be inserted into the pancreatic duct during ERCP with improved capacity to perform diagnostics and therapy.
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Affiliation(s)
- John E Chandler
- Human Photonics Laboratory, Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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23
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Ansorge C, Strömmer L, Andrén-Sandberg Å, Lundell L, Herrington MK, Segersvärd R. Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy. Br J Surg 2012; 99:1076-1082. [DOI: 10.1002/bjs.8784] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Background
The morbidity rate after pancreaticoduodenectomy remains high (20–50 per cent) and postoperative pancreatic fistula (POPF) is a major underlying factor. POPF has been reported to be associated with pancreatic consistency (PC) and pancreatic duct diameter (PDD). The aim was to quantify the risk of pancreaticojejunostomy-associated morbidity (PJAM) by means of a structured intraoperative assessment of both characteristics.
Methods
This single-centre prospective observational study included pancreaticoduodenectomies performed between 2008 and 2010 with a standardized duct-to-mucosa end-to-side pancreaticojejunostomy. PC and PDD were assessed during surgery and classified into four grades each (from very hard to very soft, and from larger than 4 mm to smaller than 2 mm, respectively). PJAM was defined as POPF (grade B or C in International Study Group on Pancreatic Fistula classification) or symptomatic peripancreatic collection of either abscess or fluid. PJAM of at least Clavien grade IIIb was considered severe.
Results
PJAM and POPF were observed in 24 (21·8 per cent) and 17 (15·5 per cent) of 110 patients respectively. Softer PC and smaller PDD were risk factors for POPF (both P < 0·001), symptomatic peripancreatic collections (P = 0·071 and P = 0·015) and PJAM (both P < 0·001). Combining consistency and duct characteristics in a composite classification the PJAM risk was stratified as ‘high’ (both risk factors, PJAM incidence 51 per cent), ‘intermediate’ (softer PC or smaller PDD, PJAM 26 per cent) or ‘low’ (no risk factors, PJAM 2 per cent). Severe PJAM was observed only in patients with smaller PDD.
Conclusion
A high-risk pancreatic gland had a 25-fold higher risk of PJAM after pancreaticoduoden- ectomy than a low-risk gland. This simple classification can contribute to more individualized patient management and allow stratification of study cohorts with homogeneous POPF risk.
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Affiliation(s)
- C Ansorge
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
| | - L Strömmer
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
| | - Å Andrén-Sandberg
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
| | - M K Herrington
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
- Department of Biology, Adams State College, Alamosa, Colorado, USA
| | - R Segersvärd
- Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
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Hall TC, Dennison AR, Garcea G. The diagnosis and management of Sphincter of Oddi dysfunction: a systematic review. Langenbecks Arch Surg 2012; 397:889-98. [PMID: 22688754 DOI: 10.1007/s00423-012-0971-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/31/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Sphincter of Oddi dysfunction (SOD) is a benign pathological syndrome. The clinical manifestations may be a consequence of an anatomical stenosis or sphincter dysmotility. Manometry is invasive and has an associated morbidity. Non-invasive investigations have been evaluated to ameliorate risk but have unknown efficacy. The review aims to critically appraise current evidence for the diagnosis and management of SOD. METHODS A systematic review of articles containing relevant search terms was performed. RESULTS Manometry is the current gold standard in selecting which patients are likely to benefit from endoscopic sphincterotomy (ES). It can, however, be misleading. Several non-invasive investigations were identified. These have poor sensitivities and specificities compared to manometry. There is a paucity of data examining the investigation's specific ability to select patients for ES. Outcomes of ES for Type I SOD are favourable irrespective of manometry. Types II and III SOD may respond to an initial trial of medical therapy. Manometry may predict response to ES in Type II SOD, but not in Type III. CONCLUSIONS Non-invasive investigations currently lack sufficient sensitivities and specificities for routine use in diagnosing SOD. Type I SOD should be treated with ES without manometry. Manometry may be useful for Type II SOD. However, whilst data is lacking a therapeutic trial of Botox(TM) or trial stenting may bean alternative. Careful and thorough patient counselling is essential. Type III SOD is associated with high complications from manometry and poor outcomes from ES. Alternative diagnoses should be thoroughly sought and its management should be medical.
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Affiliation(s)
- Thomas C Hall
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK.
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25
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Takakura K, Sumiyama K, Munakata K, Ashida H, Arihiro S, Kakutani H, Tajiri H. Clinical usefulness of diffusion-weighted MR imaging for detection of pancreatic cancer: comparison with enhanced multidetector-row CT. ACTA ACUST UNITED AC 2011; 36:457-62. [PMID: 21643939 DOI: 10.1007/s00261-011-9728-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to compare diffusion-weighted magnetic resonance imaging (DWI) and multidetector-row computed tomography (MDCT) for detection of primary pancreatic cancer by reviewing images of patients at high risk for pancreatic cancer with main pancreatic duct (MPD) dilatation shown by magnetic resonance cholangiopancreatography (MRCP). METHODS From October 2007 to September 2009, 83 patients who had undergone both DWI and MDCT with MPD dilatation were identified and were reviewed by four readers (2 radiologists and 2 gastroenterology fellows). Diagnostic performance in pancreatic cancer detection was evaluated with 95% confidence intervals. Statistically significant differences in the detection of pancreatic cancer between DWI and MDCT were compared by receiver operating characteristics and the confidence of the diagnosis by the paired t test. RESULTS Thirty-two of 83 patients were diagnosed with primary pancreatic cancer by histological evaluation of 15 surgical and 2 endoscopic ultrasound-guided fine needle aspiration samples, and by the clinical course for 15 lesions. Overall average accuracies of pancreatic cancer detection by the four readers were 84% with DWI and 86% with MDCT. CONCLUSION Performance of DWI and MDCT was equivocal for detection of pancreatic cancer in a high-risk population with MPD dilatation. The combination of MRCP and DWI for detection of pancreatic cancer allowed identification of a high-risk population and tumor detection with a single imaging modality with no need for contrast medium.
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Affiliation(s)
- Kazuki Takakura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
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Choi YJ, Byun JH, Kim JY, Kim MH, Jang SJ, Ha HK, Lee MG. Diffuse pancreatic ductal adenocarcinoma: Characteristic imaging features. Eur J Radiol 2008; 67:321-328. [PMID: 17766075 DOI: 10.1016/j.ejrad.2007.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/19/2007] [Accepted: 07/25/2007] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate imaging findings of diffuse pancreatic ductal adenocarcinoma. MATERIALS AND METHODS We included 14 patients (4 men and 10 women; mean age, 64.5 years) with diffuse pancreatic ductal adenocarcinoma on the basis of retrospective radiological review. Two radiologists retrospectively reviewed 14 CT scans in consensus with respect to the following: tumor site, peripheral capsule-like structure, dilatation of intratumoral pancreatic duct, parenchymal atrophy, and ancillary findings. Eight magnetic resonance (MR) examinations with MR cholangiopancreatography (MRCP) and seven endoscopic retrograde cholangiopancreatography (ERCP) were also reviewed, focusing on peripheral capsule-like structure and dilatation of intratumoral pancreatic duct. RESULTS CT revealed tumor localization to the body and tail in 11 (79%) patients and peripheral capsule-like structure in 13 (93%). The intratumoral pancreatic duct was not visible in 13 (93%). Pancreatic parenchymal atrophy was not present in all 14 patients. Tumor invasion of vessels was observed in all 14 patients and of neighbor organs in 8 (57%). On contrast-enhanced T1-weighted MR images, peripheral capsule-like structure showed higher signal intensity in five patients (71%). In all 11 patients with MRCP and/or ERCP, the intratumoral pancreatic duct was not dilated. CONCLUSION Diffuse pancreatic ductal adenocarcinoma has characteristic imaging findings, including peripheral capsule-like structure, local invasiveness, and absence of both dilatation of intratumoral pancreatic duct and parenchymal atrophy.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Ji-Youn Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Se Jin Jang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Sgouros SN, Pereira SP. Systematic review: sphincter of Oddi dysfunction--non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy. Aliment Pharmacol Ther 2006; 24:237-46. [PMID: 16842450 DOI: 10.1111/j.1365-2036.2006.02971.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sphincter of Oddi dysfunction is a benign, functional gastrointestinal disorder for which invasive endoscopic therapy with potential complications is often recommended. AIMS To review the available evidence regarding the diagnostic accuracy of non-invasive methods that have been used to establish the diagnosis and to estimate the long-term outcome after endoscopic sphincterotomy. METHODS A systematic review of English language articles and abstracts containing relevant terms was performed. RESULTS Non-invasive diagnostic methods are limited by their low sensitivity and specificity, especially in patients with Type III sphincter of Oddi dysfunction. Secretin-stimulated magnetic resonance cholangiopancreatography appears to be useful in excluding other potential causes of symptoms, and morphine-provocated hepatobiliary scintigraphy also warrants further study. Approximately 85%, 69% and 37%, of patients with biliary Types I, II and III sphincter of Oddi dysfunction, respectively, experience sustained benefit after endoscopic sphincterotomy. In pancreatic sphincter of Oddi dysfunction, approximately 75% of patients report symptomatic improvement after pancreatic sphincterotomy, but the studies have been non-controlled and heterogeneous. CONCLUSIONS Patients with suspected sphincter of Oddi dysfunction, particularly those with biliary Type III, should be carefully evaluated before considering sphincter of Oddi manometry and endoscopic sphincterotomy. Further controlled trials are needed to justify the invasive management of patients with biliary Type III and pancreatic sphincter of Oddi dysfunction.
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Affiliation(s)
- S N Sgouros
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
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28
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Agostini S, Garçon S, Durieux O, Guénat R, Peretti P. Aspects du pancréas normal. Variantes et malformations. ACTA ACUST UNITED AC 2005; 86:719-32. [PMID: 16142067 DOI: 10.1016/s0221-0363(05)81438-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Major advances have occurred with regards to imaging of the pancreas. In spite of harmonic imaging, US remains limited. Multi-detector CT allows excellent evaluation of the pancreatic parenchyma with multiplanar ductal and vascular reformations. MRI provides excellent evaluation of the pancreatic parenchyma using fat suppressed T1W images and excellent evaluation of the biliary tract and pancreatic duct using T2W images. Senile pancreas is characterized by atrophy and ductal dilatation, sometimes microcystic. Fatty infiltration of the pancreas could be focal or diffuse. Pancreas divisum is characterized by the absence of fusion of the pancreatic ducts with several anatomic variants. Annular pancreas results from malrotation of the pancreatic buds. MRI is the best technique to diagnose these malformations.
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Affiliation(s)
- S Agostini
- Service de Radiologie, Hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13274 Marseille Cedex 09.
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Osawa S, Kataoka K, Sakagami J, Sogame Y, Kawasaki C, Takaoka K, Yasuda H, Takatera A. Relation between morphologic changes in the main pancreatic duct and exocrine pancreatic function after a secretin test. Pancreas 2002; 25:12-9. [PMID: 12131765 DOI: 10.1097/00006676-200207000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Because pancreatic exocrine function testing methods are problematic, both imaging and functional tests are important in the diagnosis of chronic pancreatitis. AIM To evaluate the usefulness of ultrasonographic monitoring of the main pancreatic duct after a secretin test. METHODOLOGY A total of 70 subjects (30 control subjects, 26 patients with probable chronic pancreatitis, and 14 patients with definite chronic pancreatitis) were selected. The main pancreatic duct diameters were measured serially after an injection of secretin (100 IU/body). The relation between the magnitude of the duct dilation and exocrine pancreatic function on the secretin test was evaluated. RESULTS The main pancreatic duct dilated immediately after a bolus injection of secretin, showed a peak after 2-5 minutes, and recovered gradually. The response curve of the definite group had a flatter pattern than that of the other groups. For the maximal to basal duct diameter ratio, statistically significant differences were found between the control and definite groups and between the control and probable groups. In addition, the ratio correlated significantly with the maximal bicarbonate concentration and secretory volume on the secretin test. CONCLUSIONS The results of the current study indicate that exocrine pancreatic function and the morphologic changes of the main pancreatic duct are significantly related. Dynamic ultrasonographic findings may reflect pancreatic function; consequently, this test may be a useful tool in the diagnosis of chronic pancreatitis.
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Affiliation(s)
- Saori Osawa
- Third Department of Internal Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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30
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Abstract
Pancreatic abnormalities usually are detected on US when it is used for screening patients with abdominal pain and for assessment of the gallbladder and bile ducts. Pancreatic visualization is limited by bowel gas, but with experienced sonographers and newer techniques, including harmonic imaging and oral contrast US, diagnosis of pancreatic abnormalities has significantly improved compared with earlier reports. Appropriate initial diagnosis by US can tailor further investigation, and US-guided biopsy may establish definitive diagnosis.
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Affiliation(s)
- G L Bennett
- Department of Radiology, New York University Medical Center, New York, USA
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31
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Glaser J, Stienecker K. Does aging influence pancreatic response in the ultrasound secretin test by impairing hydrokinetic exocrine function or sphincter of Oddi motor function? Dig Liver Dis 2000; 32:25-8. [PMID: 10975751 DOI: 10.1016/s1590-8658(00)80040-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Secretin administration induces a brief distinct dilatation of the main pancreatic duct in healthy persons, visible at ultrasonography. Several investigations have indicated that sonographic duct measurements before and after secretin injections are a useful tool in the diagnostic screening for pancreatic disease. AIMS Aim of this study was to evaluate the influence of aging on the test results. METHODS We examined prospectively two groups of patients with distinctly different mean age, measuring the pancreatic duct diameter sonographically before, 2, 4, 6 and 10 minutes after intravenous injection of 1 CU secretin per kilogram body weight. The examination was performed in all patients on account of abdominal complaints, and pancreatic disease could be excluded by further diagnostic procedures. Group 1 consisted of 22 patients, median age 30.5 years, Group 2: 21 patients, median age 68 years. RESULTS The younger patients (Group 1) had a mean basal pancreatic duct diameter of 1.6 mm. After secretin injection they showed dilatation reading 3. 1 mm, corresponding to 94% of the basal duct diameter. The older patients (Group 2), with a basal diameter of 1.9 mm, showed a duct enlargement of about 84% to 3.5 mm. There was no statistically significant difference between the two groups concerning extent and temporal development of secretin-induced pancreatic duct dilatation. CONCLUSIONS The underlying mechanisms of response to secretin stimulation - hydrokinetic pancreatic function, sphincter of Oddi motor function, and extensibility of Wirsung's duct--do not seem to be impaired by aging. Thus, the ultrasound secretin test should be suitable for application in older patients.
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Affiliation(s)
- J Glaser
- Department of Internal Medicine and Gastroenterology, General District Hospital Fulda, Germany.
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Catalano MF, Lahoti S, Alcocer E, Geenen JE, Hogan WJ. Dynamic imaging of the pancreas using real-time endoscopic ultrasonography with secretin stimulation. Gastrointest Endosc 1998; 48:580-7. [PMID: 9852447 DOI: 10.1016/s0016-5107(98)70039-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obstructive disorders of the pancreas, including strictures, stones, sphincter of Oddi dysfunction, and pancreas divisum, are diagnostic and therapeutic challenges. Conventional extracorporeal ultrasound with secretin stimulation has been used as a noninvasive study to detect obstruction and predict outcome of therapy. Inconsistent results have been obtained because of the inherent limitations of standard ultrasonography. The aim of this study was to evaluate the behavior of the main pancreatic duct by endoscopic ultrasonography during secretin stimulation and to diagnose obstructive disorders of the pancreas. METHODS Secretin-stimulated endoscopic ultrasound (SSEUS, 1 IU/kg secretin) was performed in 20 control subjects (no pancreatic or biliary disease), 40 patients with symptomatic chronic pancreatitis, 40 patients with symptomatic pancreas divisum, 20 patients with suspected sphincter of Oddi dysfunction, and 20 patients with suspected occlusion of pancreatic duct stents. Ductal diameter was measured by endoscopic ultrasonography at baseline and at 1-minute intervals, after administration of secretin, for 15 minutes. A result was determined to be abnormal when a 1 mm or greater dilation of the pancreatic duct was observed from baseline after secretin administration. RESULTS Of the 40 patients with symptomatic chronic pancreatitis, SSEUS correctly predicted obstructive pathology (stones, strictures) in 12 of 13 patients (92%). Of the 40 patients with symptomatic pancreas divisum, 22 underwent stent therapy (16 of 22 with resolution of symptoms). SSEUS accurately predicted response to stent therapy in 13 patients (81%). Seven of twenty patients with suspected sphincter of Oddi dysfunction had abnormal sphincter manometry. SSEUS accurately predicted sphincter dysfunction in only 4 of 7 patients (57%). Finally, 20 patients with suspected occlusion of pancreatic duct stents were studied. Of the 14 stent occlusions confirmed at ERCP, SSEUS correctly predicted premature occlusion in 12 patients (86%). CONCLUSIONS SSEUS appears to be a useful diagnostic modality in the evaluation of patients with suspected obstructive disorders of the pancreas and it can predict which patients may respond to endoscopic therapy.
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Affiliation(s)
- M F Catalano
- St. Luke's Medical Center, Pancreatic Biliary Center, Milwaukee, Wisconsin, USA
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Glaser J, Mann O, Pausch J. Diagnosis of chronic pancreatitis by means of a sonographic secretin test. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1994; 15:195-200. [PMID: 7930780 DOI: 10.1007/bf02924194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The pancreatic duct can be demonstrated today by sonography in about 90% of all persons examined. In 159 persons, aged 18-79 yr, we measured sonographically the pancreatic duct diameter before and after intravenous secretin injection. After secretin stimulation, 20 healthy controls and 90 patients without pancreatic disease showed a distinct pancreatic duct dilatation of 93 and 94% of basal duct diameter lasting only several minutes. No distinct secretin-induced duct enlargement was observed in 35 of 40 patients with chronic pancreatitis. Patients with chronic pancreatitis and circumscript duct stenosis even had a marked and longer-lasting duct dilatation of 156% of basal duct diameter after secretin stimulation. This study showed a high reliability of the sonographic secretin test in the diagnosis of chronic pancreatitis--even in an early stage--recording a sensitivity of 92.5%, a specificity of 93%, and a predictive value of 84%.
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Affiliation(s)
- J Glaser
- Department of Internal Medicine, Municipal Hospital Kassel, Germany
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Bolondi L, Li Bassi S, Gaiani S, Santi V, Gullo L, Barbara L. Impaired response of main pancreatic duct to secretin stimulation in early chronic pancreatitis. Dig Dis Sci 1989; 34:834-40. [PMID: 2656136 DOI: 10.1007/bf01540267] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the present study we compared sonographic measurements of the main pancreatic duct (MPD) following maximal secretin stimulation (75 CU intravenous in 1 min) in 15 chronic pancreatitis patients (CP) with those of 18 normal control subjects. The mean caliber of the main pancreatic duct was 1.2 +/- 0.4 mm in controls and 1.8 +/- 0.9 in patients with chronic pancreatitis (P less than 0.025). In the control group a dilatation of the duct with a peak at the third minute was found. In patients with chronic pancreatitis a flatter profile of the response curve with a slower increase and inconstant return to basal values was found. A statistically significant difference was found between absolute variations of MPD caliber over basal values (1.7 +/- 1.06 in controls vs 0.8 +/- 0.69 in CP, P less than 0.005) and the dilatation index [(Dmax - D)/D] (1.31 +/- 0.6 in controls vs 0.66 +/- 0.69 in CP, P less than 0.005). The mean percent increase at the third minute was 131% in control subjects vs 53% of patients with CP (P less than 0.0005). In the five cases of CP showing a caliber increase greater than 100%, a persistent dilatation (100-200%) was found 15 min after secretin administration. At this time, the mean percent increase over basal value in controls was 25%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Bolondi
- Department of Medicine and Gastroenterology, University of Bologna, Italy
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Cunningham JJ, Bicani-Faulls M. Predictive Value of Technically Adequate and Normal Abdominal Sonography Prior to Retrograde Cholangiopancreatography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1989. [DOI: 10.1177/875647938900500302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A prospective study identified 85 patients who had endoscopic retrograde cholangiopancreatography (ERCP) within 60 days of a technically adequate sonogram of the biliary tree and pancreas which was normal using strict criteria. Eighty-two normal sonograms ultimately proved to be true-negatives and two were false-negatives. The correct diagnosis is uncertain in one patient. The three incorrect or potentially incorrect sonograms were performed in the first year of a 2-year study. Patients who have both a technically acceptable and completely normal sonogram of the biliary tree and pancreas are very unlikely to have an abnormal ERCP.
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Affiliation(s)
- Jerome J. Cunningham
- Division of Ultrasound, Department of Radiology, Ohio State University Medical Center, Columbus, OH 43210
| | - Monica Bicani-Faulls
- Division of Ultrasound, Department of Radiology, Ohio State University Medical School, Columbus, Ohio
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Glaser J, Högemann B, Schneider M, Hultsch E, van Husen N, Gerlach U. Significance of a sonographic secretin test in the diagnosis of pancreatic disease. Results of a prospective study. Scand J Gastroenterol 1989; 24:179-85. [PMID: 2648557 DOI: 10.3109/00365528909093034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In a prospective study the pancreatic duct diameter was measured sonographically before and after secretin stimulation in 20 healthy controls and 59 patients with upper abdominal pain, weight loss, and/or diarrhea. Whereas healthy controls and patients without pancreatic disease after secretin stimulation showed a distinct pancreatic duct dilatation of more than 90% of basal duct diameter, no distinct secretin-induced duct enlargement was observed in most patients with chronic pancreatitis. Patients with circumscript pancreatic duct stenosis even had a marked and longer-lasting duct dilatation after stimulation. In patients with anomalies of the pancreatic duct system, no uniform response was found after secretin injection. In this study the sonographic secretin test showed a sensitivity of 92% and a specificity of 95% for diagnosis of chronic pancreatitis. The results confirm that this diagnostic method can be recommended as a reliable screening test for pancreatic disease.
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Affiliation(s)
- J Glaser
- Medical Clinic and Outpatient Clinic, University of Münster, FRG
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Glaser J, Högemann B, Krummenerl T, Schneider M, Hultsch E, van Husen N, Gerlach U. Sonographic imaging of the pancreatic duct. New diagnostic possibilities using secretin stimulation. Dig Dis Sci 1987; 32:1075-81. [PMID: 3308373 DOI: 10.1007/bf01300191] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pancreatic duct or at least parts of this structure can be demonstrated today by sonography in 75-85% of all persons examined. In 84 persons we have now measured the caliber of the sonographically visualized pancreatic duct in the region of the proximal body of the pancreas with special attention to dependence on age. The diameter of Wirsung's duct ranged from 1 to 3 mm (mean 1.9 mm) and increased significantly from the fifth decade of life onwards. After intravenous injection of the hormone secretin, healthy persons usually show a distinct duct enlargement, which also depends on age. Nine persons aged 19 through 35 (median 28) years showed a dilatation of the main pancreatic duct by about 110% following secretion injection. Nine further probands, 50-74 (median 58) years old, had a dilatation of about 70%. Eighteen patients with confirmed chronic pancreatitis and a pancreatic duct diameter not exceeding 4 mm generally showed no duct enlargement after secretin stimulation. We believe that periductal fibrosis, which is common in chronic pancreatitis, is the most important reason for these results. The use of the sonographic secretin test in the diagnosis of chronic pancreatitis should be considered.
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Affiliation(s)
- J Glaser
- Medical Clinic and Polyclinic, University of Münster, F.R.G
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Clark LR, Joffe MH, Choyke PL, Grant EG, Zeman RK. Pancreatic Imaging. Radiol Clin North Am 1985. [DOI: 10.1016/s0033-8389(22)02311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
In this study we evaluated the effect of secretin administration on the caliber of the Wirsung duct visualized by real-time ultrasonography. A maximal dose [75 clinical units (CU)] of secretin was intravenously injected in 1 min into 18 normal subjects. The duct was continuously monitored from the beginning of injection for a period of 20 min and measured at the level of the body using a calibrated optical lens. The mean caliber of the duct (basal value +/- SD = 1.2 +/- 0.4 mm) markedly increased after secretin stimulation (mean value +/- SD at 3 min = 2.9 +/- 0.8 mm). No dilatation was observed in five of these subjects after administration of 2 ml of saline. In a further four subjects a dose of 0.25 CU/kg/hr of secretin caused a much less marked dilatation of the main pancreatic duct. During dilatation a longer segment of duct is more clearly visualized; furthermore the pancreatic juice within the duodenum improves ultrasonographic imaging of the head of the pancreas.
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Manco LG, Short WF. Preoperative percutaneous pancreatography under real-time sonographic guidance. JOURNAL OF CLINICAL ULTRASOUND : JCU 1984; 12:436-440. [PMID: 6438181 DOI: 10.1002/jcu.1870120713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Hadidi A. Ultrasonic diagnosis of primary intraductal cholelith and neoplasm. GASTROINTESTINAL RADIOLOGY 1983; 8:333-6. [PMID: 6315522 DOI: 10.1007/bf01948145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This report presents 19 patients with obstructive jaundice with dilatation of the biliary tree. The obstruction was due to common hepatic duct stones in 14 and intraductal biliary neoplasm in 5. The diagnostic ultrasonographic features consisted of strong echoes with acoustic shadows in a dilated extrahepatic biliary duct for stone and echogenic protrusion into the dilated lumen casting no shadows for neoplasm. The correct diagnoses were made or suggested in 18 patients (94.7%).
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Bolondi L, Gaiani S, Casanova P, Testa S, Priori P, Labó G. Improvement of pancreatic ultrasound imaging after secretin administration. ULTRASOUND IN MEDICINE & BIOLOGY 1983; 9:497-501. [PMID: 6676961 DOI: 10.1016/0301-5629(83)90022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The pancreas is usually well recognized by ultrasound, but in some cases it is obscured by the presence of gas in the stomach and duodenum. Water and other orally administered fluids produced poor results. In this study we stimulated pancreatic juice secretion by a standard dose of intravenous secretin in 24 normal subjects, and continuously monitored the pancreatic region for a period of 20 min. Four to five minutes after hormone administration pancreatic juice outflow into the duodenum generated a fluid-filled echofree area around the head of the pancreas, allowing excellent visualization of its boundaries and other channel structures (distal common bile duct, pancreatic duct and gastroduodenal artery). This method should be utilized in selected patients whenever a pathological condition of the pancreatic head region is suspected.
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Didier D, Deschamps JP, Rohmer P, Lassegue A, Ottignon Y, Weill F. Evaluation of the pancreatic duct: a reappraisal based on a retrospective correlative study by sonography and pancreatography in 117 normal and pathologic subjects. ULTRASOUND IN MEDICINE & BIOLOGY 1983; 9:509-518. [PMID: 6676963 DOI: 10.1016/0301-5629(83)90024-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A retrospective study of 117 normal and pathologic pancreatic ducts by endoscopic retrograde cholangiopancreatography (ERCP), with ultrasonic correlation in 80 cases, confirmed the value of ultrasound in the diagnosis of ductal dilatation. The specificity of ultrasound is good: the ultrasonic discovery of a dilatation constitutes a relevant feature. Sensitivity is however poor, particularly in moderate and localized dilatations: a suggestive clinical picture requires ERCP even if sonography is in favor of a normal pancreatic duct. Correlative measurements show discrepancies, with higher ERCP values in normal subjects. The average ERCP diameter in the corporeal ductal segment is 2.6 mm. Until correlative results arising from a prospective study are available, the ultrasonic diagnosis of ductal dilatation must take into account the high normal values demonstrated by ERCP.
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