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Terumi Kamisawa - One of the best experts on this subject based on the ideXlab platform.
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Clinical implications of Accessory Pancreatic Duct
World journal of gastroenterology, 2010Co-Authors: Terumi Kamisawa, Kensuke Takuma, Taku Tabata, Naoto EgawaAbstract: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.
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DOES A PATENT Accessory Pancreatic Duct PREVENT ACUTE PANCREATITIS
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2010Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Junko Fujiwara, Hideto Egashira, Koichi Koizumi, Naoto EgawaAbstract: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.
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A patent Accessory Pancreatic Duct prevents pancreatitis following endoscopic retrograde cholangiopancreatography.
Digestive surgery, 2010Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Naoto EgawaAbstract:Background/Aim: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). We previously examined patency of the Accessory pan
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Pancreatographic investigation of Pancreatic Duct system and Pancreaticobiliary malformation.
Journal of anatomy, 2008Co-Authors: Terumi Kamisawa, Atsutake OkamotoAbstract: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.
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Pancreatographic investigation of the Pancreatic Duct system
Surgical and Radiologic Anatomy, 2007Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake OkamotoAbstract: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.
Atsutake Okamoto - One of the best experts on this subject based on the ideXlab platform.
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Pancreatographic investigation of Pancreatic Duct system and Pancreaticobiliary malformation.
Journal of anatomy, 2008Co-Authors: Terumi Kamisawa, Atsutake OkamotoAbstract: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.
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Pancreatographic investigation of the Pancreatic Duct system
Surgical and Radiologic Anatomy, 2007Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake OkamotoAbstract: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.
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Pancreatographic findings in idiopathic acute pancreatitis
Journal of Hepato-Biliary-Pancreatic Surgery, 2005Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake Okamoto, Gaku Matsumoto, Tomomi OkamotoAbstract: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.
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patent Accessory Pancreatic Duct prevent post ercp pancreatitis
Gastrointestinal Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake OkamotoAbstract:Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake Okamoto Background/Aims: Pancreatitis is the most important complication of ERCP. Moreover, efforts to understand its pathogenesis and to identifyways to reduce the frequency and severity of this complication have shown no convincing benefit to date. Although very complex factors are involved in the development of postERCP pancreatitis, mechanical injury to the papilla causing papillary edema and restriction of Pancreatic juice flow, and hydrostatic injury from over-injection are the most common causes. We have prospectively examined patency of the Accessory Pancreatic Duct (APD) by dye-injection ERP. We examined the role of the APD in vivo, and proposed a new way to prevent post-ERCP pancreatitis. Methods: During ERP, 2 or 3 ml of contrast medium containing indigo carmine was injected through a catheter in the main Pancreatic Duct (MPD) with usual pressure in 443 cases. Dye excretion from the minor papilla was then observed endoscopically. Results: Of 312 controls, patency of the APD was observed in 43%, whereas in 51 patients with acute pancreatitis, only 8 (16%) had a patent APD (p<0.01). In particular, patency of the APD was seen in only one of 17 patients with acute biliary pancreatitis. Patency of the APD showed a close relationship to the course and terminal shape of the APD. The long-type APD, which joined the MPD at its neck portion and ran straight from the upper dorsal Pancreatic Duct, wasmore frequently patent than the short-typeAPDwhich joined the MPD near its first inferior branch and followed a descending course (75.5% patency vs. 36.0%, p<0.01). Regarding terminal shape of theAPD, patency of the cudgel (89.2%) and spindle type (92.0%) was more frequent than of the branch type (5.9%) or saccular type (16.7%) (p<0.01). According to the above findings, we retrospectively examined patency of the APD in 25 patients with acute pancreatitis after diagnostic ERP (6500 cases). Patency of the APD was estimated at only 8% (2/25). Furthermore, 3 cases showing acute pancreatitis after stone extraction with endoscopic balloon dilatation, exhibited nonpatent APD. Conclusions: A patent APD may prevent acute pancreatitis by lowering the pressure in the MPD. During ERCP, in cases with short type APD or APD with branch or saccular terminal shape, endoscopists should be more cautious and never persist when selective cannulation is difficult, or alternatively consider prophylactic Pancreatic stenting. *T1536 There Are Benefits of Overnight Observation After Outpatient ERCP Jeffrey D. Linder, Paul R. Tarnasky There is debate regarding whether patients require overnight observation (OBS) after outpatient ERCP. Independent of whether pts develop complications, there may be benefit from inpatient OBS. The purpose of this study was to assess utilization of iv fluids, parenteral analgesics (PA) and anti-emetics (AE), as well as patient satisfaction following outpatient ERCP. Methods: 77 consecutive pts undergoing outpatient ERCP from 7/2003 to 11/2003 where included in this prospective study. Medications, endoscopic interventions and iv fluids during endoscopy were recorded. Pts were evaluated for possible discharge from recovery based on low risk for PEP, lack of symptoms of pain, nausea/vomiting, and ability to tolerate oral fluids. PA, AE, iv and oral fluid intake were recorded during recovery and OBS period if admitted. Pain scores (5 point scale) were obtained at both recovery and OBS periods. Pts were queried for satisfaction at discharge for OBS pts and at 24 hours after discharge for pts discharged from the recovery room. Results: 27 pts were discharged home after recovery and 50 pts were admitted for OBS. There were 3 pts who developed PEP (1 OBS, 2 discharged). Pts undergoing sphincterotomy or sphincter of Oddi manometry were more likely to be admitted (p=0.01 and 0.001, respectively). Similar volumes of iv fluids (median 900cc) were administered to both discharged and OBS pts during recovery. Compared to discharged pts, those who were admitted following recovery were significantly more likely to receive PA (36 vs 11%, p=0.02) or AE (30% vs 14%, p=0.01). 10 OBS pts vs. 2 discharged pts had emesis during recovery. Pain scores were higher in OBS vs discharged pts (3.1 vs. 0.7, p=0.0005). The OBS pts received an average of 1338 cc of iv fluids. 10 pts vomitedwithin 24hr after admission. Patient satisfaction scores were higher in the admitted pts than in the discharged pts. Conclusions: Pts with post-procedure symptoms of pain and nausea/vomiting are more likely to benefit from overnight OBS, however, even pts who do not require PA or AE in recoverymay require thesemedications during an overnight OBS. The need for PA or AE is most frequently from post-procedure symptoms that are not from PEP. Patient satisfaction is improved by admission for overnight OBS following ERCP.
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Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis
Gastrointestinal Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake OkamotoAbstract:Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake Okamoto Background/Aims: Pancreatitis is the most important complication of ERCP. Moreover, efforts to understand its pathogenesis and to identifyways to reduce the frequency and severity of this complication have shown no convincing benefit to date. Although very complex factors are involved in the development of postERCP pancreatitis, mechanical injury to the papilla causing papillary edema and restriction of Pancreatic juice flow, and hydrostatic injury from over-injection are the most common causes. We have prospectively examined patency of the Accessory Pancreatic Duct (APD) by dye-injection ERP. We examined the role of the APD in vivo, and proposed a new way to prevent post-ERCP pancreatitis. Methods: During ERP, 2 or 3 ml of contrast medium containing indigo carmine was injected through a catheter in the main Pancreatic Duct (MPD) with usual pressure in 443 cases. Dye excretion from the minor papilla was then observed endoscopically. Results: Of 312 controls, patency of the APD was observed in 43%, whereas in 51 patients with acute pancreatitis, only 8 (16%) had a patent APD (p
Naoto Egawa - One of the best experts on this subject based on the ideXlab platform.
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Clinical implications of Accessory Pancreatic Duct
World journal of gastroenterology, 2010Co-Authors: Terumi Kamisawa, Kensuke Takuma, Taku Tabata, Naoto EgawaAbstract: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.
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DOES A PATENT Accessory Pancreatic Duct PREVENT ACUTE PANCREATITIS
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 2010Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Junko Fujiwara, Hideto Egashira, Koichi Koizumi, Naoto EgawaAbstract: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.
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A patent Accessory Pancreatic Duct prevents pancreatitis following endoscopic retrograde cholangiopancreatography.
Digestive surgery, 2010Co-Authors: Taku Tabata, Terumi Kamisawa, Kensuke Takuma, Hajime Anjiki, Naoto EgawaAbstract:Background/Aim: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). We previously examined patency of the Accessory pan
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Pancreatographic investigation of the Pancreatic Duct system
Surgical and Radiologic Anatomy, 2007Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake OkamotoAbstract: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.
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Pancreatographic findings in idiopathic acute pancreatitis
Journal of Hepato-Biliary-Pancreatic Surgery, 2005Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Atsutake Okamoto, Gaku Matsumoto, Tomomi OkamotoAbstract: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.
Hitoshi Nakajima - One of the best experts on this subject based on the ideXlab platform.
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patency of the Accessory Pancreatic Duct evaluated by dye injection endoscopic retrograde pancreatography methods and clinical implication
Digestive Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Masami Yoshiike, Hitoshi NakajimaAbstract:The Accessory Pancreatic Duct (APD) is sometimes developmentally obliterated near the duodenum. We evaluated patency of the APD by dye-injection endoscopic retrograde pancreatography (ERP). We injected 2–3 mL contrast medium containing indigocarmine into the main Pancreatic Duct (MPD) via a selectively cannulated endoscopic catheter. Patency of the APD was evaluated by observing the excretion of dye from the minor duodenal papilla. Of the 291 control cases studied, 43% demonstrated a patent APD. Patency of the APD in patients with acute pancreatitis was only 17%, significantly lower than that of controls (P < 0.01). Mean caliber of patent APD was 1.6 ± 0.5 mm, significantly greater than the 1.1 ± 0.5 mm of non-patent APD (P < 0.01). Regarding the terminal shape of the APD, spindle- and cudgel-type APD were frequently patent (93% and 88%, respectively, (P < 0.01). With respect to APD course, long-type APD showed most frequent patency (75%, P < 0.01). Dye-injection ERP represents a simple and definitive method for examining APD function. A patent APD may prevent acute pancreatitis by reducing pressure in the MPD. Patency of the APD might be dependent on Duct caliber, course, and terminal shape.
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patent Accessory Pancreatic Duct prevent post ercp pancreatitis
Gastrointestinal Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake OkamotoAbstract:Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake Okamoto Background/Aims: Pancreatitis is the most important complication of ERCP. Moreover, efforts to understand its pathogenesis and to identifyways to reduce the frequency and severity of this complication have shown no convincing benefit to date. Although very complex factors are involved in the development of postERCP pancreatitis, mechanical injury to the papilla causing papillary edema and restriction of Pancreatic juice flow, and hydrostatic injury from over-injection are the most common causes. We have prospectively examined patency of the Accessory Pancreatic Duct (APD) by dye-injection ERP. We examined the role of the APD in vivo, and proposed a new way to prevent post-ERCP pancreatitis. Methods: During ERP, 2 or 3 ml of contrast medium containing indigo carmine was injected through a catheter in the main Pancreatic Duct (MPD) with usual pressure in 443 cases. Dye excretion from the minor papilla was then observed endoscopically. Results: Of 312 controls, patency of the APD was observed in 43%, whereas in 51 patients with acute pancreatitis, only 8 (16%) had a patent APD (p<0.01). In particular, patency of the APD was seen in only one of 17 patients with acute biliary pancreatitis. Patency of the APD showed a close relationship to the course and terminal shape of the APD. The long-type APD, which joined the MPD at its neck portion and ran straight from the upper dorsal Pancreatic Duct, wasmore frequently patent than the short-typeAPDwhich joined the MPD near its first inferior branch and followed a descending course (75.5% patency vs. 36.0%, p<0.01). Regarding terminal shape of theAPD, patency of the cudgel (89.2%) and spindle type (92.0%) was more frequent than of the branch type (5.9%) or saccular type (16.7%) (p<0.01). According to the above findings, we retrospectively examined patency of the APD in 25 patients with acute pancreatitis after diagnostic ERP (6500 cases). Patency of the APD was estimated at only 8% (2/25). Furthermore, 3 cases showing acute pancreatitis after stone extraction with endoscopic balloon dilatation, exhibited nonpatent APD. Conclusions: A patent APD may prevent acute pancreatitis by lowering the pressure in the MPD. During ERCP, in cases with short type APD or APD with branch or saccular terminal shape, endoscopists should be more cautious and never persist when selective cannulation is difficult, or alternatively consider prophylactic Pancreatic stenting. *T1536 There Are Benefits of Overnight Observation After Outpatient ERCP Jeffrey D. Linder, Paul R. Tarnasky There is debate regarding whether patients require overnight observation (OBS) after outpatient ERCP. Independent of whether pts develop complications, there may be benefit from inpatient OBS. The purpose of this study was to assess utilization of iv fluids, parenteral analgesics (PA) and anti-emetics (AE), as well as patient satisfaction following outpatient ERCP. Methods: 77 consecutive pts undergoing outpatient ERCP from 7/2003 to 11/2003 where included in this prospective study. Medications, endoscopic interventions and iv fluids during endoscopy were recorded. Pts were evaluated for possible discharge from recovery based on low risk for PEP, lack of symptoms of pain, nausea/vomiting, and ability to tolerate oral fluids. PA, AE, iv and oral fluid intake were recorded during recovery and OBS period if admitted. Pain scores (5 point scale) were obtained at both recovery and OBS periods. Pts were queried for satisfaction at discharge for OBS pts and at 24 hours after discharge for pts discharged from the recovery room. Results: 27 pts were discharged home after recovery and 50 pts were admitted for OBS. There were 3 pts who developed PEP (1 OBS, 2 discharged). Pts undergoing sphincterotomy or sphincter of Oddi manometry were more likely to be admitted (p=0.01 and 0.001, respectively). Similar volumes of iv fluids (median 900cc) were administered to both discharged and OBS pts during recovery. Compared to discharged pts, those who were admitted following recovery were significantly more likely to receive PA (36 vs 11%, p=0.02) or AE (30% vs 14%, p=0.01). 10 OBS pts vs. 2 discharged pts had emesis during recovery. Pain scores were higher in OBS vs discharged pts (3.1 vs. 0.7, p=0.0005). The OBS pts received an average of 1338 cc of iv fluids. 10 pts vomitedwithin 24hr after admission. Patient satisfaction scores were higher in the admitted pts than in the discharged pts. Conclusions: Pts with post-procedure symptoms of pain and nausea/vomiting are more likely to benefit from overnight OBS, however, even pts who do not require PA or AE in recoverymay require thesemedications during an overnight OBS. The need for PA or AE is most frequently from post-procedure symptoms that are not from PEP. Patient satisfaction is improved by admission for overnight OBS following ERCP.
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Patency of the Accessory Pancreatic Duct evaluated by dye-injection endoscopic retrograde pancreatography: Methods and clinical implication
Digestive Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Masami Yoshiike, Hitoshi NakajimaAbstract:The Accessory Pancreatic Duct (APD) is sometimes developmentally obliterated near the duodenum. We evaluated patency of the APD by dye-injection endoscopic retrograde pancreatography (ERP). We injected 2–3 mL contrast medium containing indigocarmine into the main Pancreatic Duct (MPD) via a selectively cannulated endoscopic catheter. Patency of the APD was evaluated by observing the excretion of dye from the minor duodenal papilla. Of the 291 control cases studied, 43% demonstrated a patent APD. Patency of the APD in patients with acute pancreatitis was only 17%, significantly lower than that of controls (P
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Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis
Gastrointestinal Endoscopy, 2004Co-Authors: Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake OkamotoAbstract:Patent Accessory Pancreatic Duct Prevent Post-ERCP pancreatitis Terumi Kamisawa, Naoto Egawa, Hitoshi Nakajima, Atsutake Okamoto Background/Aims: Pancreatitis is the most important complication of ERCP. Moreover, efforts to understand its pathogenesis and to identifyways to reduce the frequency and severity of this complication have shown no convincing benefit to date. Although very complex factors are involved in the development of postERCP pancreatitis, mechanical injury to the papilla causing papillary edema and restriction of Pancreatic juice flow, and hydrostatic injury from over-injection are the most common causes. We have prospectively examined patency of the Accessory Pancreatic Duct (APD) by dye-injection ERP. We examined the role of the APD in vivo, and proposed a new way to prevent post-ERCP pancreatitis. Methods: During ERP, 2 or 3 ml of contrast medium containing indigo carmine was injected through a catheter in the main Pancreatic Duct (MPD) with usual pressure in 443 cases. Dye excretion from the minor papilla was then observed endoscopically. Results: Of 312 controls, patency of the APD was observed in 43%, whereas in 51 patients with acute pancreatitis, only 8 (16%) had a patent APD (p
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Clinical significance of the Accessory Pancreatic Duct.
Hepato-gastroenterology, 2003Co-Authors: Terumi Kamisawa, Naoto Egawa, Kouji Tsuruta, Hitoshi Nakajima, Nobuhiro Sakaki, Atsutake OkamotoAbstract:BACKGROUND/AIMS The Accessory Pancreatic Duct is the smaller and less constant Pancreatic Duct in comparison with the main Pancreatic Duct. We investigated the patency of the Accessory Pancreatic Duct and its role in Pancreatic pathophysiology. METHODOLOGY Dye-injection endoscopic retrograde pancreatography was performed in 411 patients. In patients in whom the main Pancreatic Duct could be selectively cannulated, contrast medium with indigo carmine was injected through the catheter. Excretion of the dye from the minor duodenal papilla was observed endoscopically. RESULTS Patency of the Accessory Pancreatic Duct was 43% of the 291 control cases. In the 46 patients with acute pancreatitis, 8 (17%) had a patent Accessory Pancreatic Duct. The difference in patency between this group and the normal group was significant (p < 0.01). Especially, patency of the Accessory Pancreatic Duct was only 8% of the 13 patients with acute biliary pancreatitis. In the patients with Pancreaticobiliary maljunction, biliary carcinoma occurred in 72% of patients with a nonpatent Accessory Pancreatic Duct, but in contrast, it occurred only in 30% of those with a patent Accessory Pancreatic Duct. This difference was significant (p < 0.05). Lower amylase level in the bile of patients with Pancreaticobiliary maljunction with a patent Accessory Pancreatic Duct was frequently observed than those with a nonpatent Accessory Pancreatic Duct. CONCLUSIONS A patent Accessory Pancreatic Duct may prevent acute pancreatitis by lowering the pressure in the main Pancreatic Duct. In cases of Pancreaticobiliary maljunction with a patent Accessory Pancreatic Duct, the incidence of carcinogenesis of the bile Duct might be lower, as the reflux of the Pancreatic juice to the bile Duct might be reduced by the flow of the Pancreatic juice into the duodenum through the Accessory Pancreatic Duct.
Wei-hui Liu - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic dissection of refractory Pancreatic Duct stricture via Accessory Pancreatic Duct approach for concurrent treatment of anomalous Pancreaticobiliary junction in aging patients.
Clinical interventions in aging, 2019Co-Authors: Tao Wang, Dan-qing Liu, Xu-dong Wen, Bing-yin Zhang, Wei-hui LiuAbstract:Background Although endoscopic management of Pancreatic strictures by dilation and stenting is well established, some high-grade strictures are refractory to conventional methods. Here, we report a novel technique via Accessory Pancreatic Duct (APD) approach to simultaneously release chronic pancreatitis-associated Pancreatic stricture and correct anomalous Pancreaticobiliary junction (APBJ). Due to APBJ and stricture of proximal main Pancreatic Duct, the APD turned out to be compensatory expansion. The stiff stenosis was dissected along the axial of APD using needle-knife electrocautery or holmium laser ablation, and then the supporting stent was placed into the Pancreatic body Duct. By doing so, the outflow channels of Pancreatic and biliary Ducts were exquisitely separated. Patients and methods Two patients aged 69 and 71 years underwent stricture dissection and stent insertion for fluent drainage of Pancreatic juice. The postoperative course was marked by complete abdominal pain relief and normal blood amylase recovery. In the first patient, wire-guided needle-knife electrocautery under fluoroscopic control was applied to release refractory stricture. The second patient was treated by SpyGlass pancreatoscopy-guided holmium laser ablation to lift Pancreatic stricture. Results Plastic stents in APD were removed at 3 months after surgery, and magnetic resonance imaging at 6 months showed strictly normal aspect of the Pancreatic Duct. Conclusion Although both cases were successful without severe complications, we recommend this approach only for selected patients with short refractory Pancreatic strictures due to chronic pancreatitis. In order to prevent severe complications (bleeding, perforation or pancreatitis), direct-view endoscopy-guided electrotomy needs to be developed.
