Chronic Pancreatitis Duct Research Articles

Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure.

The technique of longitudinal V-shaped excision of the ventral pancreas for small duct chronic pancreatitis is presented and its efficacy in terms of pain relief and improvement of quality of life is evaluated. Small duct chronic pancreatitis has been regarded as a classical indication for more or less extensive resection, in which the therapeutic success of pain relief is offset by the considerable risk of significant perioperative mortality and morbidity and the burden of substantial loss of pancreatic function. Thirteen patients with severe pain who were diagnosed with small duct pancreatitis (defined as maximal Wirsungian ductal diameter of 2 mm) underwent longitudinal V-shaped excision of the ventral pancreas. In addition to routine pancreatic workup, a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Assessment of exocrine and endocrine function included fecal chymotrypsin and the pancreolauryl test as well as oral glucose tolerance, serum concentrations of insulin, C-peptide, and hemoglobin A1c. The interval between symptoms and surgery ranged from 12 months to 10 years (mean, 5.4 years). Median follow-up was 30 months (range, 12-48 months). There were no deaths. Overall morbidity was 15.4%. In 92% of patients, complete relief of symptoms was obtained. Median pain score decreased by 95%. Physical status, working ability, and emotional and social functioning scores improved by 40%, 50%, 67%,, and 75%, respectively. Global quality-of-life index increased by 67%. Occupational rehabilitation was achieved in 69% of patients. Exocrine and endocrine pancreatic function was well preserved. In small duct chronic pancreatitis, longitudinal V-shaped excision of the ventral pancreas is a safe and effective alternative to resection procedures. The new technique provides pain relief and improvement of quality of life, thus offering the benefit of a resection procedure without its burden.

Scanning electron microscopic observation of pancreatic ducts in WBN/Kob rats.

To elucidate changes of pancreatic ducts in chronic pancreatitis, we observed pancreatic tissues with light microscopy and scanning electron microscopy, and corrosion casts of pancreatic ducts with scanning electron microscopy, in male WBN/Kob rats, considered a spontaneously occurring chronic pancreatitis model. At 3 months of age, hemorrhage and increased fibrosis were found in part of the pancreatic tail. After 3 months of age, pancreatic ductal lumina exhibited a winding form and inner surfaces showed long cilia and crater-like depressions. Fibrous tissues gradually extended into exocrine tissues and islets after 6 months of age. Most pancreatic ductal lumina developed a helical form with many deep depression at 14 months of age. It is suggested that increased pancreatic ductal pressure causes these findings.

慢性すい炎に対するすい管ドレナージ手術

慢性すい炎に対するすい管ドレナージ手術

Gastrointestinal cancer-associated antigen CA 19-9 in histological specimens of pancreatic tumours and pancreatitis.

The expression of the gastrointestinal cancer associated antigen CA 19-9, defined by the monoclonal antibody 1116 NS 19-9, was studied by immunoperoxidase staining in routine formalin-fixed, paraffin-embedded tissue sections from normal pancreata, pancreata with pancreatitis and from benign and malignant pancreatic neoplasms. The formalin-fixed specimens were treated with pepsin, which enhanced the staining intensity. Eighty-five per cent of well to moderately differentiated adenocarcinomas were positive. The staining was most intense in the apical border of cells lining the lumina of malignant glands, and in mucus inside the lumina, but cytoplasmic staining was also seen. In poorly differentiated adenocarcinomas the number of positive cells was smaller and in anaplastic carcinomas only occasional cells were stained. All mucinous cystadenomas and cystadenocarcinomas stained intensely, whereas serous cystadenomas, and all benign and malignant islet cell tumours were negative. Ducts in chronic pancreatitis and in normal pancreata were positive in 96% and 79%, respectively, but the staining was focal and usually weaker than in carcinomas. In acute pancreatitis (92% positive) the staining was more intense, and the CA 19-9 expression was seen predominantly in small terminal ducts and in centroacinar cells. There was an apparent correlation between the degree of differentiation of the ductal adenocarcinomas and the expression of CA 19-9, whereas the correlation between tissue expression and serum levels of CA 19-9 was poor.

Redrainage of the pancreatic duct in chronic pancreatitis

Recurrent pain after a drainage procedure for chronic pancreatitis is considered an indication for pancreatectomy. To evaluate whether redrainage might be a better alternative, 14 patients who underwent redrainage after a failed pancreaticojejunostomy were reviewed. Patients with previous pseudocyst drainage were excluded. Initial operations included five caudal, three longitudinal, and six side-to-side pancreaticojejunostomies. Nine patients treated since 1974 had ERCP, which showed obstructed segments of pancreatic duct in the head of the gland. Two caudal pancreaticojejunostornies and one longitudinal pancreaticojejunostomy were revised to longitudinal pancreaticojejunostomies. The other 11 were revised to side-to-side pancreaticojejunostomies. Operative findings confirmed undrained segments of the pancreatic duct in the pancreatic head. Postoperatively, one patient died from hemorrhage and four patients had complications. At most recent follow-up from 6 months to 20 years postoperatively, three patients were pain free and six had substantial relief from pain (71 percent). Of eight patients who were not diabetic before redrainage, diabetes developed in only two. Only one of seven patients without pancreatic exocrine insufficiency required pancreatic enzymes after redrainage. Patients with recurrent pain after pancreaticojejunostomy should undergo ERCP. If segments of the pancreatic duct are obstructed, redrainage can provide satisfactory pain relief with a minimal loss of endocrine and exocrine function. This problem is best avoided by initial complete drainage of the major and minor pancreatic ducts.

Endoscopic manometry of the sphincter of Oddi and pancreatic duct in chronic pancreatitis.

Pancreatic duct pressure was studied by endoscopic manometry in 12 patients with chronic pancreatitis and in 9 patients with a normal pancreas (suspected biliary dyskinesia). To study the effect of increased intraduodenal concentration of pancreatic enzymes, the duct pressure was measured before and after intraduodenal enzyme infusion. The mean pancreatic duct pressure was 12 (range, 6-25) mm Hg and 18 (range, 6-38) mm Hg in the pancreatitis and 'control' groups, respectively. The occasional patient in each group who had a high duct pressure also had an elevated sphincter of Oddi pressure. A significant correlation between the two pressures was found in both groups of patients. During intraduodenal infusion of pancreatic enzymes a decrease of the pancreatic duct pressure occurred in only two patients. We conclude that an increased pancreatic duct pressure is not a frequent finding in chronic pancreatitis. An elevation of the duct pressure can also be found in patients without pancreatitis. The sphincter of Oddi pressure appears to be more important for the pancreatic duct pressure than the severity of the pancreatitis. Intraduodenal infusion of enzymes, as done in our study, had an inconsistent effect on the pancreatic duct pressure.

Pancreatic duct pressure in chronic pancreatitis

The wide variety of surgical procedures available for the relief of pain in patients with chronic pancreatitis attests to a lack of understanding of the precise mechanisms responsible for the onset of pain in this condition. In the development of surgical procedures designed to “decompress” the pancreatic duct in chronic pancreatitis, it has been tacitly assumed that pancreatic duct hypertension exists and is important in the pathophysiology of the disease. In 19 patients with chronic pancreatitis and dilated pancreatic ducts, pancreatic duct pressure was significantly higher than in control patients. In view of the dramatic relief of preoperative pain after procedures for decompressing the pancreatic ducts, ductal hypertension has been confirmed as an important mechanism of pain production in this group of patients.

Ultrasonic Demonstration of a Dilated Pancreatic Duct in Chronic Pancreatitis—the “Double Dot” Sign

Australasian RadiologyVolume 23, Issue 1 p. 40-42 Ultrasonic Demonstration of a Dilated Pancreatic Duct in Chronic Pancreatitis—the “Double Dot” Sign IVAN VUJIC M.D., IVAN VUJIC M.D. Assistant Professor, Department of Radiology, Medical University of South Carolina, Charleston, SCSearch for more papers by this authorHUBERT C. MEREDITH M.B.B.S., M.R.A.C.R., Corresponding Author HUBERT C. MEREDITH M.B.B.S., M.R.A.C.R. Assistant Professor, Department of Radiology, Medical University of South Carolina, Charleston, SCDepartment of Radiology, Medical University of SC, 171 Ashley Avenue, Charleston, SC 29403Search for more papers by this author IVAN VUJIC M.D., IVAN VUJIC M.D. Assistant Professor, Department of Radiology, Medical University of South Carolina, Charleston, SCSearch for more papers by this authorHUBERT C. MEREDITH M.B.B.S., M.R.A.C.R., Corresponding Author HUBERT C. MEREDITH M.B.B.S., M.R.A.C.R. Assistant Professor, Department of Radiology, Medical University of South Carolina, Charleston, SCDepartment of Radiology, Medical University of SC, 171 Ashley Avenue, Charleston, SC 29403Search for more papers by this author First published: March 1979 https://doi.org/10.1111/j.1440-1673.1979.tb02103.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume23, Issue1March 1979Pages 40-42 RelatedInformation

Three-Dimensional Reconstruction of the Pancreatic Ducts in Chronic Pancreatitis

A three-dimensional reconstruction of the pancreatic ducts has been made from the secondary branches of the main duct to the terminal acini. This has been carried out by cutting serial sections from surgical specimens of the pancreas from 10 patients with alcoholic calcifying chronic pancreatitis, specimens from 2 patients with a small carcinoma obstructing the main pancreatic duct, and a normal pancreas. The lesions of calcifying pancreatitis demonstrated by this method showed characteristically: (a) spotty distribution of the lesions which were related to the ducts; (b) a frequent finding in the ducts of plugs of precipitated protein, which tended to evolve into calculi by deposition of calcium on their surface (these plugs rarely contained mucopolysaccharide); (c) all sizes of duct were involved and showed irregular dilation, loss of lining epithelium, encroachment of periductal connective tissue to form stenosis, pancreatic cysts or complete disappearance of acini, and ducts in the territory drained by a blocked duct. In chronic pancreatitis secondary to an obstruction in the main pancreatic duct, the lesions are different in almost every respect from those described above.