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ENDOSCOPIC PANCREATOCHOLANGIOGRAPHY WITH SPECIAL REFERENCE TO MANOMETRIC METHOD
Author(s) -
Kasugai Tatsuzo,
Kuno Nobuyoshi,
Kizu Minoru
Publication year - 1973
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1973.tb129743.x
Subject(s) - medicine , pancreatic duct , pancreas , pancreatitis , pancreatic carcinoma , stenosis , common bile duct , radiology , nuclear medicine , pancreatic cancer , cancer
Of 496 attempted endoscopic examinations, 451 (90‐9%) cannulations were successfully performed, resulting in 251 endoscopic pancreatograms (EPG), 152 endoscopic pancreatocholangiograms (EPCG) and 48 endoscopic cholangiograms (ECG). The selected ducts were visualized in 88‐3% of attempted cases. A manometer was developed by the writers to measure and control the injecting pressure of the contrast medium in EPCG. In EPCG or EPG, sufficient opacification of all pancreatic ducts, including fine pancreatic ducts, and/or the biliary system, including the intrahepatic bile ducts was obtained with a pressure of 90 to 110 mm on the manometer scale (370 to 870 mm of water). In ECG a pressure of 80 to 100 mm was used. The total volume of injecting dye was 15 to 22 ml for EPCG, 10 to 20 ml for EPG and over 15 ml for ECG. The rate of injection was 0‐2 to 0‐6 ml/sec. Eight cases of carcinoma of the head of the pancreas and 10 cases of pancreatic carcinoma located in the body and/or tail were diagnosed by EPCG. The findings of pancreatic carcinoma in EPG were characterized by stenosis and obstruction of the main pancreatic duct as well as sometimes by a filling defect in the pancreatic field which was formed mainly by the branches of the pancreatic duct and fine pancreatic ducts and occasionally by acini. Obstructed type, stenosed type, mixed type, and pancreatic field defect type were encountered, in that descending order of frequency. Chronic pancreatitis was classified into 3 groups: minimal, moderate and advanced, according to a grading of findings in EPCG. In 157 cases of chronic pancreatitis, 68 showed minimal, 60 moderate and 29 advanced stages of chronic pancreatitis. The criteria for EPCG diagnosis of chronic pancreatitis were evaluated by the study of postmortem pancreatograms and by histological investigation. A correlation between results from both investigations was demonstrated in 79% of normal findings and in all cases of chronic pancreatitis diagnosed by post‐mortem pancreatograms. The ‘grading of the severity of pancreatitis by histological examination confirmed the accuracy of the post‐mortem pancreatogram diagnosis in 92% of cases diagnosed as minimal pancreatitis, in 88% of moderate cases and 100% of advanced cases. Various diseases of the biliary system were successfully confirmed by EPCG. This group included 3 cases of carcinoma of the gallbladder, 6 of carcinoma of the bile duct, some metastatic liver tumours, a liver abscess. Many patients were shown to have gallstones, of whom a number had negative or doubtful results at routine X‐ray examinations. It appears that EPCG is one of the most reliable procedures to detect diseases of the pancreatic and biliary systems, especially space‐occupying lesions and also chronic inflammatory changes in the pancreas.