Caliber Of Main Pancreatic Duct Research Articles

An imaging-based model to predict the malignant potential of intraductal papillary mucinous neoplasm of the pancreas.

To develop and validate imaging-based models for predicting the malignancy risk of intraductal papillary mucinous neoplasm (IPMN). We retrospectively analyzed data from 241 IPMN patients who underwent preoperative CT and MRI for model development. Cyst size, presence and size of the enhancing mural nodule (EMN), main pancreatic duct (MPD) diameter, thickened/enhancing cyst wall, abrupt MPD caliber change with distal atrophy, and lymphadenopathy were assessed. Multiple logistic regression models predicting malignancy risk were created using either continuous (Model C) or dichotomized variables (Model D) using these imaging features. Validation included internal (n = 55) and external (n = 43) datasets. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and compared with that of the international guideline-based model (Model F). Model C identified age, EMN size, MPD diameter, and lymphadenopathy as independent predictors on CT, and age and presence and size of EMN on MRI. Model D identified age ≥ 68, cyst size ≥ 31 mm, EMN ≥ 6 mm, MPD ≥ 7 mm, and lymphadenopathy as independent predictors on CT, and age ≥ 68, EMN ≥ 4.5 mm, and lymphadenopathy on MRI. Model C (AUC, 0.763-0.899) performed slightly better than Model D (AUC, 0.753-0.912) without statistical significance. No significant difference was observed between Models C and F (AUC, 0.729-0.952). Combining Model C with obstructive jaundice improved performance (AUC, 0.802-0.941) without statistical significance. Our imaging-based models effectively predicted the malignancy risk of IPMNs, comparable to international consensus guidelines. Imaging features are important for predicting the malignant potential of IPMNs. Our imaging-based model may help determine surgical candidacy for patients with IPMNs. Non-invasively determining the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) allows for appropriate treatment decision-making We identified multiple imaging features that are associated with malignant transformation and developed models for this prediction. Our model performs comparably with international consensus guidelines in predicting the malignant potential of IPMNs.

Incidence and factors associated with stent dysfunction and pancreatitis after gastroduodenal stenting for malignant gastric outlet obstruction.

Background and study aims Endoscopic gastroduodenal stent (GDS) deployment is currently a standard treatment for malignant gastric outlet obstruction (mGOO) in patients with limited life expectancy; however, stent dysfunction (SD) and complicated pancreatitis often occur after GDS deployment. We investigated incidence and contributing factors of SD and complicated pancreatitis. Patients and methods We retrospectively reviewed 203 patients who underwent initial GDS deployment for palliation of mGOO symptoms between October 2017 and July 2022, including 109 who underwent GDS deployment across the duodenal papilla (sub-cohort). Results SDs, including tumor ingrowth (n = 26), kinking (n = 14), and migration (n = 13), occurred in 68 patients (33.5%). Cumulative SD incidence was 41.1% (95% confidence interval, 32.6-49.4%). SD incidence increased to 0.4%, 0.16%, and 0.06% per day at < 8, 8-16, and>16 weeks, respectively. On multivariate analysis, Niti-S pyloric/duodenal stent deployment (sub-distribution hazard ratio [sHR] 0.26, P = 0.01) and survival length ≥ 90 days (sHR 2.5, P = 0.01) were respectively identified as favorable and risk factors significantly associated with SD. Pancreatitis developed in 14 patients (12.8%) in the sub-cohort, which had significantly higher parenchymal diameter ( P < 0.01) and lower main pancreatic duct (MPD) caliber ( P < 0.01) than the non-pancreatitis cohort. On multivariate analysis, MPD caliber < 3 mm independently predicted pancreatitis (odds ratio 6.8, P = 0.03). Conclusions Deployment of the Niti-S pyloric/duodenal stent, with conformability even for angulated strictures, significantly reduced the incidence of SD. Stent selection, life expectancy, and MPD caliber should be taken into consideration during decision-making for GDS deployment for mGOO.

Stratification Based on Risk Factors at Diagnosis Could Predict Progression in Patients with Pancreatic Cysts.

Predicting the risk of malignant transformation in pancreatic cyst patients is challenging. We retrospectively investigated the risk factors for malignant transformation in pancreatic cyst patients. Patients with pancreatic cysts diagnosed using imaging tests were followed from November 2008 to December 2021. A significant change was defined as the additional development of high-risk stigmata (HRS), worrisome features (WFs), or pancreatic cancer during monitoring. In total, 479 patients were analyzed, with a median observation period of 50months. Forty-four patients (9.2%) showed significant changes, and eight (1.7%) developed pancreatic cancer. The univariate analysis showed that the cyst diameter at diagnosis (≥ 14mm), main pancreatic duct (MPD) diameter at diagnosis (≥ 3mm), presence of multilocular cysts, and an inconsistent MPD caliber were significant predictive factors for a significant change. One point was assigned for each significant factor. We grouped the patients into three groups: the low-risk group (total score 0), medium-risk group (score 1-2), and high-risk group (score 3-4). The high-risk group had a higher risk of a significant change than the medium- and low-risk groups (age-adjusted HRs for the medium-risk and high-risk groups were 3.0 and 5.2 compared with the low-risk group). Stratification based on risk factors may help predict the development of significant changes in pancreatic cyst patients.

MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm.

BackgroundAbrupt change in the caliber of the main pancreatic duct (MPD) with distal pancreatic atrophy (PA) was considered as one of worrisome features in the International Association of Pancreatology guideline and American College of Gastroenterology guideline for the management of intraductal papillary mucinous neoplasms (IPMNs). However, this feature was not included in other guidelines. Moreover, the association between PA alone and malignancy in IPMNs has not been fully evaluated. In the present study, we investigated the role of image-based PA in identifying malignant IPMNs or invasive carcinoma.MethodsA total of 186 patients with IPMNs were included for analysis. The tumor size, location, MPD diameter, presence of a mural nodule (MN), and PA were evaluated using magnetic resonance imaging. Demographic information and serum carbohydrate antigen 19-9 and carcinoembryonic antigen (CEA) levels were also collected. IPMNs with high-grade dysplasia and associated invasive carcinoma were regarded as malignant IPMNs.ResultsPA was observed in 34 cases (18.3%). The occurrence of malignant IPMNs or invasive carcinoma in patients with PA were significantly higher than in those without PA (52.9% vs. 22.3%; 44.1% vs. 8.9%, all P < 0.01). Multivariate logistic regression analysis showed that PA was an independently associated factor for malignant IPMNs [odds ratio (OR) = 2.69, 95% confidence interval (CI): 1.07-6.78] or invasive carcinoma (OR = 7.78, 95%CI: 2.62-23.10) after modified with confounders. Subgroup analysis in MPD-involved IPMNs also indicated that PA was an independently associated factor for invasive carcinoma (OR = 9.72, 95%CI: 2.43-38.88). PA had a similar performance with MPD plus MN [the area under the curve (AUC) was both 0.71] in identifying malignancy. PA had a higher performance in identifying invasive carcinoma in MPD-involved IPMNs than MN (AUC = 0.71 vs. 0.65, P = 0.02).ConclusionOur data showed that imaging-based PA was associated with malignancy or invasive carcinoma regardless of abrupt change in the caliber of MPD in IPMNs. PA had an acceptable performance in identifying malignant IPMNs.

Assessment of Malignancy Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas on MDCT

To assess the malignancy potential of intraduct papillary mucinous neoplasms (IPMNs) on multidetector-row computerized tomography according to the 2012 International Consensus Guidelines (ICG). This study retrospectively collected IPMNs confirmed by surgery from 2016 to 2019. The imaging findings of IPMNs were analyzed. IPMNs were classified as malignancy in the presence of high-grade dysplasia or invasive carcinoma and began in the presence of low- and intermediate-grade dysplasia. A total of 207 patients (mean age: 63.7 ± 7.9 years) were included, and the prevalence of malignancy was 28.0% (58 of 207). According to the 2012 ICG, the imaging findings of IPMNs were divided into worrisome features (WFs) and high-risk stigmata (HRS). The malignancy of IPMN with only one WF was relatively low (1.4%, 3 of 207). In multivariate regression analyses, the independent factors of IPMNs were enhanced mural nodule ≥5 mm (odds ratio [OR] = 19.5, 95% confidence interval [CI] 6.8-55.4), abrupt change in the main pancreatic duct caliber with distal pancreatic atrophy (OR = 4.6, 95%CI 1.67-12.71), and thickened enhanced cyst walls (OR = 2.9, 95%CI 1.1-8.2). When the presence of more than two WFs or HRS (score ≥ 3) was regarded as indicating the malignancy potential of IPMNs on multidetector-row computerized tomography, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 89.7%, 75.8%, 79.7%, 59.1%, and 95.0%, respectively. According to the ICG in 2012, patients with IPMNs with only one WF have a low risk for malignancy, and the presence of at least two WFs or any HRS (score ≥3) suggests malignant IPMNs.

Clinical Feasibility of Abbreviated Magnetic Resonance With Breath-Hold 3-Dimensional Magnetic Resonance Cholangiopancreatography for Surveillance of Pancreatic Intraductal Papillary Mucinous Neoplasm

To determine the clinical feasibility of abbreviated magnetic resonance image (MRI) using breath-hold 3-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) (aMRI-BH) for pancreatic intraductal papillary mucinous neoplasm (IPMN) surveillance. In this retrospective study, 123 patients with 158 pancreatic IPMNs (pathologically proven [n = 73] and typical image feature with ≥2-year stability [n = 85]) who underwent conventional MRI (cMRI) consisting of contrast-enhanced pancreatobiliary MRI with conventional and BH-3D-MRCP were included. Two readers independently evaluated aMRI-BH protocols consisting of heavily T2-weighted, precontrast T1-weighted, and BH-3D-MRCP sequences. The diagnostic performance of aMRI-BH for detecting malignant IPMNs was assessed using the following criteria: category 3, presence of mural nodule 5 mm or bigger and/or main pancreatic duct (MPD) 10 mm or bigger; category 2, more than one of the following: cyst size 30 mm or greater, mural nodule smaller than 5 mm, thickened cyst walls, MPD of 5 to 9 mm, lymphadenopathy, and an abrupt MPD caliber change with distal atrophy; and category 1, none of the above. Categories 2 or 3 were considered positive results of surveillance. Interreader agreement of image features by intraclass correlation and κ statistics were analyzed. The total acquisition times of cMRI and aMRI-BH were 32.7 ± 8 and 5.5 ± 2.1 minutes, respectively (P < 0.01). Among 158 IPMNs, 33 lesions were malignant. The aMRI-BH presented a sensitivity of 100% and a negative predictive value of 100% for evaluating malignant IPMNs in both readers, with substantial interreader agreements (intraclass correlation or к values, range: 0.73-0.93 for cMRI and 0.57-0.94 for aMRI-BH) in significant imaging features based on revised Fukuoka guidelines, except for thickened cyst walls and lymphadenopathy (к values: 0.10 and 1.00 for cMRI and 0.13 and 0.49 for aMRI-BH, respectively). The aMRI-BH provided high sensitivity and negative predictive value to evaluate malignant IPMNs by using predetermined criteria, and aMRI-BH might be a potential tool for pancreatic IPMN surveillance with significantly lower acquisition time.

Pancreatic duct stenosis: Differential diagnosis between malignant and benign conditions at secretin-enhanced MRCP

PurposeTo define imaging criteria of benign and malignant nature in patients with main pancreatic duct (MPD) stenosis. Materials-methodsS-MRCPs of 35 patients with pancreatitis and 14 with adenocarcinoma were evaluated. ResultsAdenocarcinoma caused higher prevalence of complete stenosis (14/14–100% vs 17/35–49%), dilated side-branches (14/14–100% vs 18/35–51%) and lower prevalence of duct-penetrating sign (0/14–0% vs 31/35–89%). The number of stenoses was higher in benign conditions (mean 1.4 Vs 1). Upstream MPD diameter was higher in cancer-induced stenoses (4.5 vs 2.9mm). ConclusionsSingle complete stenosis with dilated side branches, increased MPD caliber and absent duct-penetrating sign are suggestive of malignancy.

Imaging comparison of tubular and colloid pancreatic adenocarcinoma arising from intraductal papillary mucinous neoplasm on multidetector CT

PurposeThis study aims to compare tubular pancreatic ductal adenocarcinoma (tPDAC) and colloid subtype pancreatic ductal adenocarcinoma (cPDAC) associated with intraductal papillary mucinous neoplasms (IPMNs) on computed tomography. MethodsAn institutional review board-approved retrospective study included patients with either IPMN tPDAC or cPDAC. Enhancing mural nodules (MN), solid component (SC), main pancreatic duct (MPD) diameter, and abrupt change in MPD caliber were evaluated. ResultsA total of 22 patients with cPDAC and 17 patients with tPDAC showed no significant difference in MPD size. MN and SC were seen in cPDAC/tPDAC in 55%/18% and 9%/53%, respectively. Abrupt change in MPD caliber was seen in cPDAC/tPDAC at 18%/59%. ConclusioncPDAC and tPDAC differ in the frequency of MN, SC, and changes in MPD caliber.

Sendai criteria is safe for follow up of patients with branch duct IPMN

Introduction: Branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas can exhibit various degrees of dysplasia, and pancreatic cancer may develop in up to 20%. The Sendai Criteria recommend that patients with ‘high-risk stigmata' (jaundice, enhanced solid component, and main pancreatic duct size ≥10 mm) should undergo resection. Patients with ‘worrisome features' (cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, main pancreatic duct size 5–9 mm, abrupt change in main pancreatic duct caliber with distal pancreatic atrophy, lymphadenopathy, and clinical acute pancreatitis) should be evaluated by endoscopic ultrasonography. The objective of this study is to analyze our population of patients with BD-IPMN. Methods: We perform a retrospective analysis of a prospective database including population of with type II IPMNs. Patients were selected for follow up according to 2006 Sendai criteria. All the patients completed the follow up at our institution exclusively. Results: 118 BD-IPMN were diagnosed. Mean age of 66 (31–91). Most were incidentally diagnosed. Only 10% required surgery. The reason to indicate surgery were: pain (8), the presence of mural nodules (1) and increase in size (3). No patient presented invasive cancer on pathology examination. Coexistence of oncological disease was found in 15% of these patients. Conclusion: The management of small BD-IPMNs remains controversial. The 2012 guidelines should be considered to indicate surgery and patients who do not undergo resection should undergo careful surveillance. Sendai criteria is a safe strategy for follow up of patients with type II IPMN.

Prevalence and Outcomes of Cystic Neoplasm of the Pancreas in Immunosuppressed Patients With Solid Organ Transplantation

Introduction: To determine the prevalence of incidental pancreatic cystic neoplasms (PCNs) in solid organ transplant (SOT) recipients and describe the clinical course of these lesions in patients on chronic immunosuppressive therapy after transplantation. Methods: Using organ transplant databases at Mayo Clinic Florida, we retrospectively reviewed medical records of all patients who received a SOT between 2000 and 2013. Records of cross-sectional abdominal imaging were searched for the diagnosis of pancreatic cyst(s). We also reviewed radiographic imaging to confirm the presence of PCNs. The “worrisome features” were defined as: main pancreatic duct (MPD) involvement (dilation >6 mm), mural nodule, abrupt change in the MPD caliber with distal pancreatic atrophy. The characteristics of the PCN at the initial and follow-up imaging were compared. Cyst size was considered to have changed if there was a difference of ≥5 mm. Results: Of 3,188 patients, 11.4% (n=356) had at least 1 incidental PCN detected on imaging. The prevalence of PCN increased with age; was more common in females (14.7%) than in males (9.7%); and more common in liver transplant recipients (14.9%) as compared to kidney (5%), lung (3%), and heart (6%) transplant patients. The median diameter of the largest pancreatic cyst was 7.0 mm (range: 1-31) and in 6.8% of patients, the cysts were ≥2 cm. Two patients (0.5%) had worrisome features at the time of pancreatic cyst diagnosis. One patient who had a mural nodule at the time of cyst diagnosis had no evidence of malignant transformation after 71 months of follow-up. One patient with branch duct intraductal papillary mucinous neoplasms (IPMN) and MPD involvement died of a non-pancreatic related cause 2 months after the cyst diagnosis. In a cohort of 155 patients with follow-up examination (median follow-up of 39 months), only 2 patients (1.3%) developed worrisome features on follow-up imaging. One case with a newly developed mural nodule underwent pancreatic surgery, with a pathologic diagnosis of high-grade dysplasia. One case with progressive MPD dilatation noted during the follow-up did not undergo surgical resection due to multiple comorbidities. The majority (83%) of pancreatic cysts evaluated at follow-up were either unchanged or smaller in size. Although 16% of patients had increased cyst size during follow-up, none of them developed malignancy or had pancreatic-related morbidity. Conclusion: PCNs are common in SOT recipients. In PCN without high-risk features, the development of features worrisome for cancer is a rare event. Therefore, PCNs can be managed conservatively and their presence should not affect patients’ eligibility for transplant.

Surgery Indeed has an Important Role in Long‐Term Outcome in Patients with Pancreatic Head Cancer

We read with interest the article by Petermann et al. [1] in the August 2013 issue of World Journal of Surgery. First of all, we would like to congratulate the authors for their very interesting article. In this retrospective study 101 pancreatic head resections due to pancreatic ductal adenocarcinoma were analyzed. The authors wanted to assess the impact of postoperative complications, stratified by severity, on long-term survival of patients after pancreatic head resection for ductal adenocarcinoma. However, we have several concerns about their conclusions. First, the authors concluded that surgery is not associated with severe postoperative complications. Surgery is the cornestone in the treatment of pancreatic cancer. Pancreaticoduodenectomy (PD) is the standard surgical treatment of pancreas head cancer. Using an optimal pancreatic reconstruction technique is thought to be a major prophylactic measure to minimize the risk of PD-related complications. Also, there are many possibilities of type of reconstruction as well as many possibilities for pancreaticojejunostomies (PJA): (1) layer with or without telescope, (2) layer, end-to-end, end-to-side, ‘‘duct to mucosa,’’ ‘‘Blumgart‘s’’ anastomosis, etc. [2]. Further, we don’t agree with authors’ conclusion that surgery is not associated with severe postoperative complications. They did not mention what kind of reconstructions were performed In accordance with this we could state following facts. Delayed gastric emptying (DGE) occurs dominantly after pylorus-preserving pancreaticoduodenectomy (PPPD) and remains a leading cause of PPPD postoperative complications. Delayed gastric emptying was probably exacerbated by some intra-abdominal complications, such as an anastomotic leak or an abscess. Problems could also be caused by the surgical procedure itself, namely injury to the nerve of Latarjet. In one study the incidence of DGE was significantly reduced in the pyloric ring resection group compared to controls, without an increase in dumping syndrome [3]. Most pancreatic fistulas (PF) can be managed nonoperatively, but a significant number of grade C PF do require reoperative surgical intervention. Risk factors for pancreatic fistula are well recognized and include a soft pancreatic parenchyma, small main pancreatic duct caliber, and a distal pancreatic resection (vs PD) [4]. Type of anastomosis is also very important regarding this problem. For example, there is a statistically significant decrease in fistula rate in the invagination group—PJA with invagination compared to other types of anastomoses [5]. Patients with postoperative hemorrhage often have underlying complications such as pancreatic fistula that require urgent surgical treatment. Pancreatic enzymes in combination with infection can cause erosion of the gastroduodenal artery or splenic artery stump, resulting in significant bleeding requiring immediate treatment. D. Zdravkovic (&) D. Bilanovic T. Randjelovic S. Dikic Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia e-mail: drdarkozdravkovic@gmail.com

Morphological Features of Pancreatic Stump, Other than Wirsung Diameter and Pancreatic Texture, Influence Pancreatic Fistula Rate After Pancreaticoduodenectomy

Context Pancreaticoduodenectomy (PD) is still characterized by high morbidity rates even in high volume centers, mainly represented by postoperative pancreatic fistula (POPF) and its associated further consequences. Wirsung diameter and pancreatic texture are well known features related to increased POPF risk. However, limited information about the relationship between morphological features of pancreatic stump and POPF onset is available. Objective Aim of the study was to evaluate the relationship between pancreatic stump morphology, intra-operatively assessed, and the occurrence of POPF in patients undergoing PD in an high volume center. Methods Between January 2010 and June 2012 we performed 136 PDs for benign and malignant disease; in a subgroup composed by 72 cases we realized a prospective study recording intra-operative measurements of the remnant pancreatic stump, recording surgeon’s judgment about pancreatic texture, and highlighting the caliber of main pancreatic duct, its position and the whole area. Between March 2011 and June 2012, in a consecutive series of 72 PD, we prospectively recorded the following characteristics of the pancreatic stump: surgeon’s judgment about pancreatic texture, diameter of main pancreatic duct, the whole area of pancreatic section (approximately calculated as elliptic), the distance between Wirsung duct and cranio-caudal and antero-posterior margins. In all patients, post-operative complications were recorded. Results Pancreatic fistula occurred in 19 cases (23.8%), 10 of them clinically significant (grade B and C according to ISGPF classification). In univariate analysis, mean Wirsung diameter resulted significantly smaller in patients with POPF (3.18 vs . 4.48 mm; P=0.007) and in patients with clinically significant POPF (P=0.015); searching for a cut off value, Wirsung diameter smaller than 4 mm demonstrated an association with higher POPF incidence (37.5% vs . 4.35%; P=0.003). Similarly, soft pancreas texture resulted associated with an increasing POPF rate (75% vs . 7%; P<0.001). Analyzing pancreatic stump morphology, we observed a relationship between larger stump areas and POFP development (206 mm 2 in POPF cases vs . 131 mm 2 in patients without fistula; P=0.017); moreover, main pancreatic duct decentralization appeared significantly associated with a lower POPF risk (more evident on antero-posterior axis than on cranio-caudal; P=0.019 and P=0.144, respectively). In multivariate analysis, only pancreatic stump soft texture and Wirsung diameter smaller than 4 mm were associated with POPF. Conclusion This study confirms small Wirsung diameter and soft pancreatic texture as the main determinants for POPF development. Moreover, an higher risk of failure of pancreatic anastomosis is also observed in large pancreatic stumps and when main pancreatic duct is centrally located.

Morphological and Functional Evaluation of the Pancreatic Duct with Secretin-Stimulated Magnetic Resonance Cholangiopancreatography in Alcoholic Pancreatitis Patients

The aim of this investigation was to evaluate the pancreatographic findings and dynamics of pancreatic duct diameter, as determined by secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP), in patients with acute alcoholic pancreatitis or chronic alcoholic pancreatitis and in a control group. S-MRCP was performed in patients with acute alcoholic pancreatitis who did not manifest the functional and radiological (ultrasonography and computed tomography) criteria of chronic pancreatitis (n = 21), in patients with chronic alcoholic pancreatitis (n = 28) and in a control group (n = 16). The diameter of the main pancreatic duct (MPD) was monitored before secretin administration and at 3 and 10 min after secretin administration. Morphological features were also assessed before and after the administration of secretin. All ductal diameters were significantly larger in chronic alcoholic pancreatitis (P < 0.0001). There were no differences in MPD caliber between patients with acute alcoholic pancreatitis and the control group. The percentage of variation between basal MPD diameter and at 3 min post-secretin administration was lower in patients with chronic (35.5%) pancreatitis than in those with acute alcoholic pancreatitis (52.3%) and the control group (52.5%). There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of the frequency of visualization of side branches, ductal narrowing, intraluminal filling defects, and ductal irregularity. One patient with acute alcoholic pancreatitis presented ductal criteria of chronic pancreatitis following the administration of secretin. The dynamics of MPD visualized on S-MRCP in patients with acute alcoholic pancreatitis is similar to that observed in the control group and different from that observed in patients with chronic alcoholic pancreatitis. There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of morphological pancreatographic features.

Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency

Objective Pancreatic duct stenting is now recognized as a treatment option for a number of pancreatic disorders. Although stent-induced ductal changes may result, there is little information regarding the frequency of these stent-induced changes in chronic pancreatitis and their relationship to stent occlusion and clinical response. Our objectives were to evaluate pancreatic ductal changes after endoscopic stenting in patients with preexisting radiographic evidence of chronic pancreatitis and to evaluate the relationships between ductal changes, pain response, and stent patency. Methods Twenty-five consecutive patients had 40 stent placement episodes. Main pancreatic duct diameter, pancreatitis grade, preexisting obstructive lesions, and stent-induced strictures were recorded. Pain response and stent patency were correlated with main pancreatic duct caliber change using χ 2 analysis. Results In 28 (70%) of 40 episodes, main pancreatic duct caliber increased or was unchanged after stenting; pain improved in 20 (71%) of 28. Pain improved in six (50%) of 12 patients with smaller ducts after stenting. Stent patency was documented upon retrieval in 34 episodes; most stents were occluded. Stent-induced strictures developed in 18% of 40 stent episodes. Conclusion Main pancreatic duct caliber after endoscopic stenting was not a good indicator of pain response or stent patency; main pancreatic duct was often larger, and even with stent occlusion, patients’ symptoms were frequently improved. Stent-induced strictures were infrequent, compared with values previously reported in the literature.

Evaluation of a non-breath-hold MR cholangiography technique.

To evaluate prospectively a non-breath-hold magnetic resonance (MR) cholangiographic technique. Twenty-nine non-breath-hold, heavily T2-weighted, turbo spin-echo MR cholangiograms were obtained in 28 patients and compared with 28 direct cholangiographic studies in 24 patients. MR cholangiography showed the intrahepatic ducts (IHDs) within the peripheral third of the liver and within the four hepatic segments in 100% of cases with dilated ducts. IHDs were seen in the peripheral third in 82% of cases with nondilated ducts and within the four hepatic segments in 91%. The extrahepatic duct (EHD), dilated and nondilated, was visualized in 90% of cases. Filling defects were identified in the EHD in 71% of cases and in the gallbladder in 100%. All obstructions were identified and their site and character accurately shown in most cases. The presence of IHD dilatation was accurately shown, and estimates of EHD and main pancreatic duct caliber correlated closely with those of direct cholangiography. Non-breath-hold MR cholangiography is a reliable method for depiction of the biliary system.

Impaired response of main pancreatic duct to secretin stimulation in early chronic pancreatitis

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)