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Accessory Pancreatic Duct

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Terumi Kamisawa – One of the best experts on this subject based on the ideXlab platform.

  • Clinical implications of Accessory Pancreatic Duct
    World journal of gastroenterology, 2010
    Co-Authors: Terumi Kamisawa, Kensuke Takuma, Taku Tabata, Naoto Egawa

    Abstract:

    The Accessory Pancreatic Duct (APD) is the main drainage Duct of the dorsal Pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP). With the growth, the Duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end. Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography. Patency of the APD in 46 patients with acute pancreatitis was only 17%, which was significantly lower than in control cases (P < 0.01). The terminal shape of the APD was correlated with APD patency. Based on the data about correlation between the terminal shape of the APD and its patency, the estimated APD patency in 167 patients with acute pancreatitis was 21%, which was significantly lower than in control cases (P < 0.01). A patent APD may function as a second drainage system for the main Pancreatic Duct to reduce the pressure in the main Pancreatic Duct and prevent acute pancreatitis. Pancreatographic findings of 91 patients with Pancreaticobiliary maljunction (PBM) were divided into a normal Duct group (80 patients) and a dorsal Pancreatic Duct (DPD) dominant group (11 patients). While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma, n = 42; bile Duct carcinoma, n = 6) were identified in PBM with a normal Pancreatic Duct system, only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05). Concentration of amylase in the bile of DPD dominance was significantly lower than that of normal Pancreatic Duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L, P < 0.05). In PBM with DPD dominance, most Pancreatic juice in the upper DPD is drained into the duodenum via the MIP, and reflux of Pancreatic juice to the biliary tract might be reduced, resulting in less frequency of associated biliary carcinoma.

  • DOES A PATENT Accessory Pancreatic Duct PREVENT ACUTE PANCREATITIS
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2010
    Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Junko Fujiwara, Hideto Egashira, Koichi Koizumi, Naoto Egawa

    Abstract:

    Background and Aim:  The role of the Accessory Pancreatic Duct (APD) in Pancreatic pathophysiology has been unclear. We previously examined the patency of the APD in 291 control cases who had a normal pancreatogram in the head of the pancreas by dye-injection endoscopic retrograde pancreatography (ERP). APD patency was 43% and was closely related with the shape of the terminal portion of the APD. The present study aimed to clarify the clinical implications of a patent APD.

    Methods:  Based on the underlying data, the patency rate of the APD was estimated from the terminal shape of the APD on ERP in 167 patients with acute pancreatitis.

    Results:  In patients with acute pancreatitis, stick-type APD, spindle-type APD, and cudgel-type APD, which showed a high patency, were rare, and branch-type APD and halfway-type or no APD, which showed quite low patency, were frequent in acute pancreatitis patients. Accordingly, the estimated patency of the APD in acute pancreatitis patients was only 21%. There was no significant relationship between the estimated APD patency and etiology or severity of acute pancreatitis.

    Conclusions:  The terminal shapes of the APD with low patency were frequent in acute pancreatitis patients, and estimated APD patency was only 21% in acute pancreatitis. A patent APD may function as a second drainage system to reduce the pressure in the main Pancreatic Duct and prevent acute pancreatitis.

  • A patent Accessory Pancreatic Duct prevents pancreatitis following endoscopic retrograde cholangiopancreatography.
    Digestive surgery, 2010
    Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Naoto Egawa

    Abstract:

    Background/Aim: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). We previously examined patency of the Accessory pan

Atsutake Okamoto – One of the best experts on this subject based on the ideXlab platform.

  • Pancreatographic investigation of Pancreatic Duct system and Pancreaticobiliary malformation.
    Journal of anatomy, 2008
    Co-Authors: Terumi Kamisawa, Atsutake Okamoto

    Abstract:

    To clarify the anatomy of the Pancreatic Duct system and to investigate its embryology, we reviewed 256 pancreatograms with normal Pancreatic head, 81 with pancreas divisum and 74 with Pancreaticobiliary maljunction. Accessory pancreatograms were divided into two patterns. The long-type Accessory Pancreatic Duct forms a straight line and joins the main Pancreatic Duct at the neck portion of the pancreas. The short-type Accessory Pancreatic Duct joins the main Pancreatic Duct near its first inferior branch. The short-type Accessory Pancreatic Duct is less likely to have a long inferior branch arising from the Accessory Pancreatic Duct. The length of the Accessory Pancreatic Duct from the orifice to the first long inferior branch was similar in the short- and long-type Accessory Pancreatic Ducts. The first long inferior branch from the long-type Accessory Pancreatic Duct passes though the main Pancreatic Duct near the origin of the inferior branch from the main Pancreatic Duct. Immunohistochemically, in the short-type Accessory Pancreatic Duct, the main Pancreatic Duct between the junction with the short-type Accessory Pancreatic Duct and the neck portion was located in the ventral pancreas. The long-type Accessory Pancreatic Duct represents a continuation of the main Duct of the dorsal Pancreatic bud. The short-type Accessory Pancreatic Duct is probably formed by the proximal main Duct of the dorsal Pancreatic bud and its long inferior branch.

  • Pancreatographic investigation of the Pancreatic Duct system
    Surgical and Radiologic Anatomy, 2007
    Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake Okamoto

    Abstract:

    Background
    Embryologically, the Pancreatic Duct system develops by the fusion between the dorsal and ventral Pancreatic bud Ducts. It has been suggested that the proximal part of the main dorsal Pancreatic Duct partially regresses to form the Accessory Pancreatic Duct (APD). Aim of this study was to clarify the anatomy of the Pancreatic Duct system of the head of the pancreas and investigate the embryology of the normal Pancreatic Duct system.

  • Pancreatographic findings in idiopathic acute pancreatitis
    Journal of Hepato-Biliary-Pancreatic Surgery, 2005
    Co-Authors: Terumi Kamisawa, Atsutake Okamoto, Naoto Egawa, Kouji Tsuruta, Gaku Matsumoto, Tomomi Okamoto

    Abstract:

    Background/purpose Despite extensive evaluation based on clinical history, biochemical tests, and noninvasive imaging studies, the cause of acute pancreatitis cannot be determined in 10 to 30% of patients, and a diagnosis of idiopathic acute pancreatitis is made. The purpose of this study was to clarify the pancreatographic findings in patients with idiopathic acute pancreatitis. Methods Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 34 patients with idiopathic acute pancreatitis, and the pancreatographic findings were examined. Patency of the Accessory Pancreatic Duct was examined by dye-injection endoscopic retrograde pancreatography (ERP) in 16 of the 34 patients. Results In 11 patients (32%), the following anatomic abnormalities of the Pancreatic or biliary system were demonstrated: complete pancreas divisum ( n = 5), incomplete pancreas divisum ( n = 2), high confluence of Pancreaticobiliary Ducts ( n = 2), choledochocele ( n = 1), and giant periampullary diverticulum ( n = 1). Pancreatographic findings were normal in 17 patients. Eleven of these patients were examined by dye-injection ERP, and all were found to have nonpatent Accessory Pancreatic Duct. Conclusions Anatomic abnormality of the Pancreatic or biliary system is one of the major causes of idiopathic acute pancreatitis. Closure of the Accessory Pancreatic Duct may play a role in the development of idiopathic acute pancreatitis in patients with a normal Pancreaticobiliary Ductal system.

Naoto Egawa – One of the best experts on this subject based on the ideXlab platform.

  • Clinical implications of Accessory Pancreatic Duct
    World journal of gastroenterology, 2010
    Co-Authors: Terumi Kamisawa, Kensuke Takuma, Taku Tabata, Naoto Egawa

    Abstract:

    The Accessory Pancreatic Duct (APD) is the main drainage Duct of the dorsal Pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP). With the growth, the Duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end. Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography. Patency of the APD in 46 patients with acute pancreatitis was only 17%, which was significantly lower than in control cases (P < 0.01). The terminal shape of the APD was correlated with APD patency. Based on the data about correlation between the terminal shape of the APD and its patency, the estimated APD patency in 167 patients with acute pancreatitis was 21%, which was significantly lower than in control cases (P < 0.01). A patent APD may function as a second drainage system for the main Pancreatic Duct to reduce the pressure in the main Pancreatic Duct and prevent acute pancreatitis. Pancreatographic findings of 91 patients with Pancreaticobiliary maljunction (PBM) were divided into a normal Duct group (80 patients) and a dorsal Pancreatic Duct (DPD) dominant group (11 patients). While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma, n = 42; bile Duct carcinoma, n = 6) were identified in PBM with a normal Pancreatic Duct system, only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05). Concentration of amylase in the bile of DPD dominance was significantly lower than that of normal Pancreatic Duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L, P < 0.05). In PBM with DPD dominance, most Pancreatic juice in the upper DPD is drained into the duodenum via the MIP, and reflux of Pancreatic juice to the biliary tract might be reduced, resulting in less frequency of associated biliary carcinoma.

  • DOES A PATENT Accessory Pancreatic Duct PREVENT ACUTE PANCREATITIS
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2010
    Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Junko Fujiwara, Hideto Egashira, Koichi Koizumi, Naoto Egawa

    Abstract:

    Background and Aim:  The role of the Accessory Pancreatic Duct (APD) in Pancreatic pathophysiology has been unclear. We previously examined the patency of the APD in 291 control cases who had a normal pancreatogram in the head of the pancreas by dye-injection endoscopic retrograde pancreatography (ERP). APD patency was 43% and was closely related with the shape of the terminal portion of the APD. The present study aimed to clarify the clinical implications of a patent APD.

    Methods:  Based on the underlying data, the patency rate of the APD was estimated from the terminal shape of the APD on ERP in 167 patients with acute pancreatitis.

    Results:  In patients with acute pancreatitis, stick-type APD, spindle-type APD, and cudgel-type APD, which showed a high patency, were rare, and branch-type APD and halfway-type or no APD, which showed quite low patency, were frequent in acute pancreatitis patients. Accordingly, the estimated patency of the APD in acute pancreatitis patients was only 21%. There was no significant relationship between the estimated APD patency and etiology or severity of acute pancreatitis.

    Conclusions:  The terminal shapes of the APD with low patency were frequent in acute pancreatitis patients, and estimated APD patency was only 21% in acute pancreatitis. A patent APD may function as a second drainage system to reduce the pressure in the main Pancreatic Duct and prevent acute pancreatitis.

  • A patent Accessory Pancreatic Duct prevents pancreatitis following endoscopic retrograde cholangiopancreatography.
    Digestive surgery, 2010
    Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Naoto Egawa

    Abstract:

    Background/Aim: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). We previously examined patency of the Accessory pan