Visualization Of Pancreatic Duct Research Articles

Risk factors for pancreatitis occurrence after gallstone treatment using endoscopic retrograde cholangiopancreatography.

Patients with gallstones are prone to pancreatitis after treatment using endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to explore the risk factors for pancreatitis occurrence after gallstone treatment using ERCP. A total of 193 patients treated from October 2017 to October 2020 were assigned into pancreatitis group (n=55) and non-pancreatitis group (n=138). Multivariate logistic regression analysis was utilized to analyse the risk factors for post-ERCP pancreatitis. The discrimination and accuracy of an established nomogram model were evaluated using receiver operating characteristic and calibration curves, respectively. The incidence rate of pancreatitis was 28.50% (55/193). Young age, long course of disease, gallbladder wall thickness >3 mm, sand-like stones, history of pancreatic disease, number of intubation ≥2 and absence of pancreatic duct stenting were risk factors for post-ERCP pancreatitis (P<0.05). The established model had high discrimination and accuracy. The incidence rates of pancreatitis in patients with and without pancreatic duct stenting were 11.84% (9/76) and 39.31% (46/117), respectively. The patients undergoing pancreatic duct stenting had lower serum amylase levels 6, 12 and 24 h after ERCP than those of patients who did not. Patients with gallstones have a higher risk of developing pancreatitis. Young age, long course of disease, gallbladder wall thickness >3 mm, sand-like stones, history of pancreatic disease, pancreatic duct visualization and number of intubation ≥2 are risk factors for post-ERCP pancreatitis.

Neostigmine® Improves Pancreatic Duct Visualization in Magnetic Resonance Cholangiopancreatography and Could Be a Cheap Alternative for Secretin.

Background:To determine the effect of intramuscular administration of Neostigmine® on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain.Methods:We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine®-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine®. Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine®.Results:Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine® administration in all patients, from 1.84 ± 0.98 to 3.41 ± 1.27 mm in the head, 1.34 ± 0.42 mm to 2.5 ± 0.49 mm in the body and 0.72 ± 0.52 mm to 1.78 ± 0.43 mm in the tail (mean ± SD, P < .0001). Neostigmine® helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine®, and in the fourth patient, Neostigmine® improved visualization of multiple pancreatic duct stenosis.Conclusion:Neostigmine®-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.

Risk factors of pancreatitis after percutaneous transhepatic biliary drainage in patients with pancreatic cancer and obstructive jaundice

Objective: To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice. Methods: A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode. Results: Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD (P<0.05). Logistic regression analysis showed that visualization of pancreatic duct (OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation (OR=0.14), pancreatic atrophy (OR=0.12) and external drainage (OR=0.11) were protective factors for pancreatitis. Conclusion: In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.

Evaluation of Pancreatic Lesions by Computed Tomography Scan: A Study Protocol

Background: The pancreas is a hidden organ and was one of the last organs in the abdomen to be analyzed by anatomists, physiologists, physicians, and surgeons. Pancreatic lesions may range from mild inflammation to malignancy. Ultrasound was the first cross-sectional technique that permitted direct imaging of the pancreas. It permitted precise visualization of pancreatic parenchyma, pancreatic ducts and bile ducts. This study aims to evaluate various pancreatic lesions using CT scan and assess their correlation with histopathological findings.&#x0D; Methodology: This will be an observational study conducted at department of radiodiagnosis, AVBRH, Wardha. Total 180 patients with pancreatic disease confirmed by clinical, laboratory and ultrasonography will be enrolled in the study. All 180 patients will undergo plain and contrast enhanced CT scan. Results will be judged, based on the observations and finding on CT scan, biochemical and histopathological reports whenever possible. Modified CT Severity Index / Mortele Modified CTSI Scoring will be used to assess severity of acute pancreatitis and acute exacerbation of chronic pancreatitis.&#x0D; Results: We expect to explore on the common etiological factors, gender and age distribution of various pancreatic diseases. Correlation between grade of acute pancreatitis according to modified CT severity index and clinical outcome of patients. In case of chronic will be evaluated. &#x0D; Conclusion: CECT is excellent diagnostic modality to stage severity of inflammatory process and staging of neoplastic lesions. Severity grading in acute exacerbation of chronic pancreatitis will be meticulously observed and significant conclusive findings will be found. CECT imaging with its postprocessing techniques represents the image of choice for diagnosis and predicting pancreatic masses.

Three-Dimensional (3D) Breath-Hold Zoomed MR Cholangiopancreatography (MRCP): Evaluation of Additive Value to Conventional 3D Navigator Triggering MRCP in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms.

To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP. To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. Retrospective. A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs. 3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality. Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P < 0.05). Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients. 3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern. 4 TECHNICAL EFFICACY: Stage 2.

Comparing compressed sensing breath-hold 3D MR cholangiopancreatography with two parallel imaging MRCP strategies in main pancreatic duct and common bile duct

PurposeTo evaluate the image quality and image consistency between 3D Breath-hold (BH)-MRCP with parallel imaging (3D-BH-PI-MRCP) and 3D-BH compressed sensing (CS)-MRCP (3D-BH-CS-MRCP) in patients with suspected pancreaticobiliary diseases, compared with 3D navigator-triggered (NT)-MRCP. Materials and methodsThe A total number of 109 patients who underwent 3D-NT-MRCP, 3D-BH-PI-MRCP and 3D-BH-CS-MRCP were prospectively enrolled in this study. The Friedman test was performed to compare quantitative values, image acquisition time, the presence of artifacts, overall image quality, and duct visualization among the three protocols. Additionally, we compared 3D-BH-PI-MRCP and 3D-BH-CS-MRCP with 3D-NT-MRCP in morphological consistency of main pancreatic duct and common bile duct (CBD) based on overall image quality score of = 4. ResultsThree MRCP methods were successfully performed in all the patients. The contrast ratio, SNR and CNR of the CBD were significantly higher for 3D-BH-CS-MRCP than those for 3D-NT-MRCP and 3D-BH-PI-MRCP images. Overall image quality did differ significantly across the three sequences. Visualization of the CBD, RHD, LHD, anterior branch, posterior branch and cystic duct was similar with the 3D-BH-CS-MRCP and 3D-BH-PI-MRCP sequences. In contrast, segment 2 or 3 branch and main pancreatic duct visualization were significantly better with 3D-BH-PI-MRCP than with 3D-BH-CS-MRCP and 3D-NT-MRCP (p < 0.001). ConclusionsBoth the two breath-hold approaches were considering the time-saving advantages without deterioration of image quality. Compared with 3D-BH-CS-MRCP, 3D-BH-PI-MRCP yielded significantly better visualization of the segment 2 and 3 branch of the intrahepatic duct and performed better consistency in main pancreatic duct and common bile duct morphology.

Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP)

To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15min were included. 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1-2.6) compared with gadobutrol (mean: 2.8-2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2-9.4min (95% confidence interval; mean 8.3min). Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.

Secretin Improves Visualization of Nondilated Pancreatic Ducts in Children Undergoing MRCP.

OBJECTIVE. The objective of our study was to assess whether secretin improves visualization of a nondilated pancreatic duct and whether it increases identification of variant duct anatomy on MRCP in pediatric patients. MATERIALS AND METHODS. This study is a delayed retrospective review of MRCP images that were prospectively obtained of 50 volunteers without a history of pancreatic disease who ranged in age from 6 to 15 years old. MRCP images (coronal 3D fast recovery fast spin-echo [FSE] and coronal single-shot FSE fat-saturated sequences) obtained before and after secretin administration were separated for review by three radiologists (reviewers 1-3). The reviewers were blinded to the purpose of the study and to secretin administration. Reviewers ranked subjective image quality (Likert scale, 1-5 points) and reported pancreaticobiliary duct anatomy and duct visibility (yes or no). Paired t tests were used for comparison of means, and the chi-square test or Fisher exact test was used for comparison of frequencies. Sensitivity and specificity of MRCP images obtained before secretin administration were judged against MRCP images obtained after secretin administration as the reference standard. RESULTS. The frequency of image quality scores of 4 or greater assigned to 3D MRCP images was statistically significantly greater after secretin administration for reviewer 2 (p < 0.0001) and reviewer 3 (p = 0.005) and approached statistical significance for reviewer 1 (p = 0.052). Mean number of visible pancreatic duct segments (head and uncinate, body, tail) was significantly greater on the MRCP images obtained after secretin administration than on those obtained before secretin administration for all reviewers (reviewer 1, 1.9 vs 1.3; reviewer 2, 1.9 vs 1.2; reviewer 3, 1.4 vs 0.8; all, p < 0.01). For all three reviewers, the sensitivity of MRCP images obtained before secretin administration was poor for variant pancreatic ductal anatomy (reviewer 1, 37.5%; reviewer 2, 50.0%; reviewer 3, 40.0%). CONCLUSION. Secretin administration improved subjective MRCP image quality, improved subjective visualization of the pancreatic duct, and provided greater sensitivity for anatomic variants such as pancreas divisum in a cohort of children with nondilated pancreatic ducts.

CHOLANGIOPANCREATOSCOPY. WORKING PROTOCOL. SEED Recommendations.

Direct endoscopic visualization of biliary and pancreatic ducts represents one step further in the journey of digestive endoscopy. It allows the identification of lesions that were previously attainable through indirect means. Directed biopsy taking has permitted a better characterization of the lesions. The use of power sources through the cholangiopancreatoscope means that it is now possible to fragment and remove refractory lithiases using traditional endoscopic systems. This document aims to define the advisable workflow when using a single-use, flexible cholangiopancreatoscope with the commercial name of SpyGlass®. Penning a set of guidelines to provide instructions on the technique, as well as tips and tricks related with the operation of these endoscopes will be a useful resource.

Contrast-enhanced magnetic resonance pancreatography with gadoteridol by heavily T2-weighted three-dimensional fluid-attenuated inversion recovery: preliminary results in healthy subjects.

The purpose of this study was to investigate the feasibility of contrast-enhanced magnetic resonance (MR) pancreatography with intravenously administered gadolinium-based contrast material (GBCM) in healthy subjects. Eight healthy male subjects (age: 29-53 years old, median: 37 years old) were enrolled. Contrast-enhanced MR pancreatography was scanned with heavily T2-weighted three-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) before and after intravenous GBCM administration. Two radiologists evaluated the images, referring to three-dimensional MR pancreatography by consensus. Scanning was performed five times at 1.5-h intervals (at 0.5, 2, 3.5, 5, and 6.5 h) after GBCM administration. In all subjects, pre-contrast-enhanced hT2W-3D-FLAIR images demonstrated no visualization of the main pancreatic duct. After GBCM administration, the main pancreatic duct was visualized in all subjects at 0.5 h (n=4, 50%) and/or 2 h (n=7, 88%). The mean signal intensity of the main pancreatic duct was 3.17 ± 0.78 at pre-contrast enhancement, 7.96 ± 4.60 at 0.5 h, and 8.08 ± 4.64 at 2 h. The signal intensity ratio of the main pancreatic duct against the pancreatic parenchyma was statistically higher (P < 0.01) at the 0.5-h and 2-h scans than that of pre-contrast-enhanced scan. Intravenously administered GBCM seeped into the pancreatic duct in sufficient concentration to alter the appearance of the main pancreatic duct by hT2W-3D-FLAIR in healthy subjects.

Secretin-enhanced MR Imaging of the Pancreas.

Secretin is a hormone that stimulates the exocrine pancreatic secretion of bicarbonate-rich fluid from the acinar cells of the pancreas that accumulates within the pancreatic ductal lumen. The exogenous administration of secretin improves the visualization of pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP), because of an enlargement of the pancreatic duct system and an increase of the fluid content within the lumen of the pancreatic ducts, responsible of an increase of MR signal. In this review, the technique of secretin-enhanced MRCP, which has the aim to depict the whole pancreatic duct system, the biliary tree, the major and minor papillae, and the duodenum, will be described. Because of the anatomic contiguity between the pancreas and the gastrointestinal tract, the presence of fluid within the stomach may overlap with the pancreatic duct system and therefore the pancreatic duct may be difficult to visualize, representing a potential source of diagnostic pitfalls. The technique to reduce the signal intensity of the static fluid present within the stomach and in the duodenal lumen is also described. The technique of secretin administration will be illustrated, with emphasis on the synchronization of secretin administration and MR image acquisition. Furthermore, the frequency and number of MRCP images necessary to achieve a temporal resolution adequate to visualize the physiologic changes in the pancreatic gland, induced by the administration of secretin, is described. The assessment of pancreatic, morphologic, and functional response to the administration of secretin, as depicted on MRCP images, will be illustrated. Finally, the indications for secretin-enhanced MRCP will be discussed to define which patients will benefit from secretin-enhanced MR imaging for their treatment planning. (©) RSNA, 2016.

Role of biliary MRI in etiological diagnosis of cholestatic icteruses in Dakar

La Bili-IRM est une méthode diagnostique d’introduction relativement récente dans l’arsenal d’exploration de la pathologie bilio-pancréatique. Il s’agit d’une technique fiable reproductible et non invasive, permettant la visualisation directe des voies biliaires et pancréatiques. Le but de ce travail était d’étudier les aspects morphologiques des principales anomalies et d’évaluer la place de la bili-IRM dans le diagnostic étiologique des ictères cholestatiques. Il s’agit d’une étude rétrospective réalisée sur 4 ans et six mois (Janvier 2008 à Juillet 2012) portant sur 17 patients colligés dans les services d’imagerie médicale du CHUN de Fann et de l’hôpital Principal de Dakar. Tous les patients ont bénéficié d’une IRM (1,5T) avec des protocoles adaptés en fonction de la pathologie explorée. Les dossiers retenus sont ceux dont le diagnostic a été établi à partir du bilan biologique et ayant bénéficié à la fois d’une bili-IRM et d’une exploration chirurgicale. Il s’agissait de 05 femmes et de 12 hommes soit un sexe ratio de 2.4. L’âge moyen des patients était de 58 ans avec des extrêmes de 35 et 81 ans. Les tumeurs de Klatskin étaient observées chez 07 patients avec une forme infiltrante dans 71% des cas et une forme exophytique dans 28% des cas. Les cancers de la vésicule biliaire étaient notés dans 28% des cas. Les cancers de la tête du pancréas représentaient 28% des cas. La lithiase de la voie biliaire principale était présente chez 05 patients avec un empierrement cholédocien dans 60% des cas et une lithiase unique dans 40% des cas. Toutes ces lésions étaient responsables d’une dilatation des VBIH. Un cas de dilatation des voies biliaires intra et extra hépatiques était retrouvé sans cause bilio-pancréatique. La bili-IRM est l’examen de choix dans l’exploration des ictères cholestatiques. Elle doit être demandée en première intention lorsqu’on suspecte une lithiase résiduelle et en deuxième intention après l’échographie lorsque cette dernière suspecte une obstruction tumorale des voies biliaires. Son association avec la TDM constitue la meilleure combinaison pour le diagnostic étiologique et le bilan préopératoire des obstructions biliaires tumorales.

Light at the End of the Tunnel: Comparative Effectiveness of Second-Generation Digital SpyGlass With First-Generation SpyGlass® Cholangioscopy Presidential Poster

Introduction: Cholangioscopy and pancreatoscopy permit direct visualization of bile and pancreatic ducts. While the 1st generation SpyGlass cholangioscopy system has demonstrated efficacy in the diagnosis and management of pancreaticobiliary diseases. The 2nd generation Spyglass system DS provides higher resolution digital imaging, and design changes, but the efficacy of this new system has not been evaluated. To evaluate diagnostic and therapeutic performance as well as adverse event rates in patients undergoing cholangioscopy with the 1st and 2nd generation SpyGlass systems. Methods: We performed a retrospective analysis of a prospective cohort of patients undergoing ERCP with 1st and 2nd generation SpyGlass cholangioscopy systems between 2013 and 2015 at a tertiary-care academic medical center. Data regarding procedure indication, diagnostic yield, procedure time, therapeutic intervention, radiation dose, and rate of complications was collected. Results: 96 patients underwent ERCP with SpyGlass cholangioscopy during the study period. 1st generation and 2nd generation SpyGlass systems were utilized in 60 and 36 patients respectively. Male patients comprised 53% of the study population and mean age was 64±16 years (range 21-93 years). Indications for cholangioscopy included stone, and stricture. Pathologic findings were identified in the common bile duct (n = 60), pancreatic duct (n = 2) and right/left hepatic ducts (n = 34). Cholangioscopy-guided biopsy (‘Spybite') was performed in 37 patients while therapeutic intervention with electrohydraulic lithotripsy for stone disease was indicated in 19 patients. Mean procedure time for completion of ERCP with cholangioscopy was shorter with 2nd generation compared with 1st generation Spyglass for both diagnostic [58±13 vs. 49±15 min, P= 0.03] and therapeutic indications [66±14 vs. 52±16 min, P= 0.02]. Radiation doses were found to be lower during use of the 2nd generation cholangioscopy system compared to the 1st generation system (447±451 vs. 271±341mGy, P= 0.04). Diagnostic yield was found to be higher at 89% (17/19) with 2nd generation compared to 76% (13/17) in 1st generation Spyglass (P= 0.05). Complications were rare and no differences were found between either group. Conclusion: 2nd generation digital SpyGlass appears to safely provide enhanced diagnostic capabilities, shorter procedure times and less radiation exposure compared to 1st generation cholangioscopy.

Secretin-Stimulated MRCP in Volunteers: Assessment of Safety, Duct Visualization, and Pancreatic Exocrine Function

The objective of our study was to investigate secretin-stimulated MRCP in terms of the safety of secretin, improvement of duct visualization, and assessment of pancreatic exocrine function. Eight hundred sixteen volunteers (370 women and 446 men; mean age, 49.7 ± 13.1 [SD] years) underwent 3D MRCP before and after secretin stimulation (1 U/kg of body weight) at 1.5 T. For the first 2 hours after secretin injection, subjects were evaluated for adverse reactions. Improvement of duct visualization after secretin stimulation was subjectively evaluated by two readers and was quantified by duct diameter measurements. Pancreatic exocrine function was evaluated subjectively by two readers according to the duodenal filling and was quantified using calibrated volumetric measurements of total excreted volume and pancreatic flow output. Two subjects (0.2%) showed flushing (minor adverse reaction). Duct visualization after secretin injection was improved for reader 1 in 468 (57.4%) and for reader 2 in 478 (58.6%) subjects, was unchanged for reader 1 in 324 (39.7%) and for reader 2 in 315 (38.6%) subjects, and was worse for reader 1 in 24 (2.9%) and reader 2 in 23 (2.8%) subjects (interrater agreement, κ = 0.925). Main pancreatic duct diameters increased significantly after secretin stimulation: pancreatic head, 10.5% (mean); body, 12.5%; and tail, 7.7%. Pancreatic exocrine function evaluated according to assessment of duodenal filling was as follows: grade 0 (restricted function) in 0.7% of subjects by both readers, grade 1 (reduced function) in 4.8% of subjects by reader 1 and 4.5% of subjects by reader 2, grade 2 (low-grade reduced function) in 31.1% of subjects by reader 1 and 26.5% of subjects by reader 2, and grade 3 (physiologic function) in 63.4% of subjects by reader 1 and 68.3% of subjects by reader 2 (interrater agreement, κ = 0.838). The mean total excreted volume was 111.8 ± 49.8 (SD) mL, and the mean pancreatic flow output was 9.6 ± 4.2 mL/min. Secretin-stimulated MRCP moderately improves main pancreatic duct visualization and allows noninvasive quantification of pancreatic exocrine function with a negligible risk of side effects.

Is prophylactic somatostatin effective to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis or hyperamylasemia? A randomized, placebo-controlled pilot trial

Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions: pre-ERCP somatostatin (0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36), post-ERCP somatostatin (0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47), or placebo (saline for 24 hours, starting 1 hour prior to ERCP; n=41). Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure (catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type). The rate of PEP was 13.7% (17/124) in the overall study sample and 16.7% (6/36), 10.6% (5/47), and 14.6% (6/41) in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively (P=0.715). The rate of post-ERCP hyperamylasemia was 19.4% (7/36), 21.3% (10/47), and 46.3% (19/41) in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively (P=0.011). Conclusions High-dose, long-term continuous infusion (0.5 mg/h for 24 hours) of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.

A control study on selective biliary cannulation technique reducing incidence of post-ERCP pancreatitis

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P 0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP. Key words: Pancreatitis; Guidewire directed selective biliary cannulation; Direct cannulation; Endoscopic retrograde cholangiopancreatography; Grading of pancreatic duct visualization

M1475: The Necessity of Pancreatic Duct Visualization in the Treatment of Pancreatic Fluid Collections Complicating Acute Pancreatitis

M1475: The Necessity of Pancreatic Duct Visualization in the Treatment of Pancreatic Fluid Collections Complicating Acute Pancreatitis

Severe Acute Pancreatitis: The Life After

BackgroundThe present study reports functional and morphological changes noted over long-term follow-up in patients with severe acute pancreatitis. MethodsThirty patients who had completed at least 6 months after recovery were included. Fecal fat, urinary d-xylose, blood sugar, C-peptide, pancreatic changes, and recurrences were studied. ResultsEtiology was gallstones (12), alcohol (10), both gallstone and alcohol (3), and idiopathic (5). Five patients were managed conservatively while 25 underwent surgery. Mean follow-up was 31.3 months. Exocrine and endocrine insufficiencies were noted in 12 (40%) and were more common in no-necrosis group compared to necrosis group (p = 0.04 and 0.28, respectively) and infected compared to sterile pancreatitis (45% vs. 25%, p = 0.55 and 50% vs. 12%, p = 0.15, respectively). Higher frequency was noted in nonvisualized, partly visualized, and dilated segment of duct. Significant proportion (8/12) had both exocrine and endocrine abnormalities and their incidence decreased as duration of follow-up increased. Urinary d-xylose excretion was abnormal in 16% and noted >1 year postrecovery. Thirty percent required >1 readmission and pain was the commonest cause. ConclusionsForty percent had functional abnormality; 16% had mucosal absorption abnormality while 30% required >1 readmission. Exocrine and endocrine insufficiencies were more prevalent in first year, and a significant proportion had both. A trend for higher functional insufficiency was observed in infected necrosis, complete or incomplete visualization of main pancreatic duct (MPD), dilated segment of MPD, and pseudocyst.

Orally administered lemon/orange juice improved MRCP imaging of pancreatic ducts

The aim of this study was to determine the effectiveness of oral administration of lemon/orange juice in improving the visualization of pancreatic ducts on MRCP. MRCP images were generated before and at every 15 min for 90 min after oral administration of lemon/orange juice in a dose of 2 ml/kg in 20 volunteers and 26 patients. The pre- and post-administration images were compared and analyzed qualitatively and quantitatively. In 20 volunteers and 26 patients, the visualization at pancreatic duct of head, body, tail, accessory pancreatic duct, and branch duct was improved after juice administration. The diameter of pancreatic ducts was augmented, and the differences in the mean values before and after oral juice were highly significant at both sites in volunteers and patients (P < 0.01). In 20 volunteers and 26 patients, after juice administration, the best visualization of the pancreatic duct was achieved at (58.98 +/- 14.96) min and (59.41 +/- 13.79) min, respectively, and the overlap imaging of oral juice was especially observed at (42.86 +/- 10.92) min and (41.63 +/- 9.32) min, respectively. Orally lemon/orange juice is an effective method to improve MRCP imaging of pancreatic ducts. The lemon/orange juice should be administered at 60 min prior to MRCP.

Effect of Somatostatin in the Prevention of Pancreatic Complications After Endoscopic Retrograde Cholangiopancreatography

The unique clinical role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating biliary tree diseases cannot be completely replaced by other modern imaging modalities such as magnetic resonance cholangiopancreatography. However, post-ERCP pancreatitis is one of the most common and life-threatening complications. Prophylactic medication in the prevention of pancreatitis during ERCP is still controversial. The objective of the present study was to investigate the role of different regimens of somatostatin in the prevention of acute pancreatitis after ERCP and analyze the risk factors contributing to post-ERCP complications. From July 1999 to September 2000, 133 patients with benign biliary disease who received ERCP for diagnosis or treatment were enrolled. Group A patients received a bolus of somatostatin infusion before ERCP, followed by continuous infusion for 12 hours. Group B patients received a bolus of somatostatin before ERCP only, and group C patients were the controls who did not receive somatostatin treatment. Serum amylase levels before and 24 hours after ERCP, and abdominal pain were recorded. There were no significant differences in bile duct and pancreatic duct visualization, ratio of diagnostic and therapeutic ERCP, procedure time, post-procedural hyperamylasemia and pancreatitis among the 3 groups. For patients with visualization of the pancreatic duct, the incidences of hyperamylasemia (serum amylase > or = 220 U/L) were higher than in patients without visualization of the pancreatic duct (p < 0.001). All 6 patients with post-ERCP pancreatitis had pancreatic duct visualization, and recovered after conservative treatment. Continuous infusion of somatostatin after ERCP does not seem to be helpful in the prevention of pancreatic complications after ERCP. Pancreatic duct visualization is a risk factor for pancreatic complications.