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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 THE ACCESSORY PANCREATIC DUCT AND Minor Duodenal Papilla
Pancreas, 2007Co-Authors: Terumi KamisawaAbstract:膵臓は，背側膵原基と腹側膵原基が癒合して形成される．背側膵原基の主導管の腹側膵管との癒合部の近位側は，発生過程において退行する例が多く，副膵管（Santorini管）と呼ばれる．我々の検討では，副膵管は形態的にlong typeとshort typeに二分され，これらは機能的にも発生学的にも異なる所見を呈した．主膵管内色素注入法による十二指腸副膵管の開存率は，43%であり，副膵管の口径，走行形態および末端像と関連性を認めた．急性膵炎例の副膵管開存率は低値であり，副膵管の開存は，第2の膵液ドレナージシステムとして，急性膵炎の発症を防止する安全弁として機能する可能性が示唆された．膵管癒合不全例では，先天性の副乳頭の閉塞性因子に，後天性の負荷因子が加わり，その相互関係で膵炎が発症することが推察され，再発性急性膵炎合併例は内視鏡的治療の良い適応と考えられた．
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endoscopic approach to the Minor Duodenal Papilla special emphasis on endoscopic management on pancreas divisum
Digestive Endoscopy, 2006Co-Authors: Terumi KamisawaAbstract:Diagnostic and therapeutic approach to the Minor Duodenal Papilla including standardized technique was reviewed. In cases in which a pancreatogram is not achieved or those in which only a small portion of the ductal anatomy is visualized via the major Duodenal Papilla, cannulation of the Minor Papilla provides a second route of access to the ductal system. Successful Minor Papilla cannulation requires meticulous attention to technique. As the orifice of the Minor Papilla is usually of pinpoint size, needle-tipped catheters are useful. As Minor Papilla cannulation in pancreas divisum carries the risk of severe pancreatitis, the procedure should be performed with more caution. In some patients with pancreas divisum, an increased resistance to flow across the small orifice results in dorsal pancreatic duct hypertension and clinical symptoms including acute recurrent pancreatitis, chronic pancreatitis, and pancreatic-type pain. Pancreas divisum patients with acute recurrent pancreatitis are the best candidates for endoscopic management for dorsal-duct decompression including endoscopic Minor Papilla sphincterotomy and stenting.
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pancreatic tumor associated with pancreas divisum
Journal of Gastroenterology and Hepatology, 2005Co-Authors: Terumi Kamisawa, Masami Yoshiike, Atsutake Okamoto, Naoto Egawa, Kouji Tsuruta, Nobuaki FunataAbstract:Abstract Background: Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. Methods: A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal Papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum. Results: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal Papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma. Conclusions: Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the Minor Duodenal Papilla might be a factor promoting oncogenesis. © 2005 Blackwell Publishing Asia Pty Ltd
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Clinical significance of the Minor Duodenal Papilla and accessory pancreatic duct
Journal of Gastroenterology, 2004Co-Authors: Terumi KamisawaAbstract: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). As development progresses, the duct of the dorsal bud undergoes varying degrees of atrophy at the Duodenal end. In cases of patent APD, smooth-muscle fiber bundles derived from the Duodenal proper muscular tunics surround the APD. The APD shows long and short patterns on pancreatography, and ductal fusion in the two types appears to differ embryologically. Patency of the APD in control cases, as determined by dye-injection endoscopic retrograde pancreatography, was 43%. Patency of the APD may depend on duct caliber, course, and terminal shape of the APD. A patent APD may prevent acute pancreatitis by reducing the pressure in the main pancreatic duct. Pancreas divisum is a common anatomical anomaly in which the ventral and dorsal pancreatic ducts do not unite embryologically. As the majority of exocrine flow is routed through the MIP in individuals with pancreas divisum, interrelationships between poor function of the MIP and increased flow of pancreatic juice caused by alcohol or diet may increase dorsal pancreatic duct pressure and lead to the development of pancreatitis. Wire-guided Minor sphincterotomy, followed by dorsal duct stenting, is recommended for acute recurrent pancreatitis associated with pancreas divisum.
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patency of the accessory pancreatic duct in chronic pancreatitis
Journal of the Pancreas, 2004Co-Authors: Terumi KamisawaAbstract:I read the paper by Hernandez Garces et al. [1] with interest and I have some questions. I have prospectively examined patency of the accessory pancreatic duct (APD) by dyeinjection endoscopic retrograde pancreatography in 410 cases (291 controls, 46 acute pancreatitis, 32 chronic pancreatitis, 27 pancreaticobiliary maljunction, and 14 intraductal Papillary mucinous tumor of the pancreas) [2, 3, 4]. Egress of dye from the Minor Duodenal Papilla observed endoscopically was taken as an indication of APD patency. Patency of the APD in the control group was 43% (125/291). APD patency was correlated to the course and shape of the APD: patency in the long type (75%) was significantly greater than in the intermediate (38%), short (34%), or ansa types (15%) (P<0.01). The shape of the terminal portion was also correlated with patency of the APD: patency in the spindle type (93%) and cudgel type (88%) was significantly greater than in the branch type (7%) and saccular type (14%) (P<0.01). Patency of the APD in patients with acute pancreatitis was 17% (8/46), significantly less than in the control group (P<0.01). I think that a patent APD may prevent acute pancreatitis by reducing pressure in the main pancreatic duct. Patency of the APD in 32 patients with chronic pancreatitis was 32%. The APD was not detected in 6 cases and obliteration of the APD near the duodenum was seen in 4 cases. Cudgel appearance of the APD was detected in 8 cases, wherein the main pancreatic duct was also dilated. I think the appearance of the APD in patients with chronic pancreatitis is sometimes changed by acquired factors due to stagnation of pancreatic juice. I wonder what the patency of APD is in patients with chronic pancreatitis in Hernandez Garces series, and how many cases show no APD or halfway APD.
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: 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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pancreatic tumor associated with pancreas divisum
Journal of Gastroenterology and Hepatology, 2005Co-Authors: Terumi Kamisawa, Masami Yoshiike, Atsutake Okamoto, Naoto Egawa, Kouji Tsuruta, Nobuaki FunataAbstract:Abstract Background: Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. Methods: A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal Papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum. Results: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal Papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma. Conclusions: Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the Minor Duodenal Papilla might be a factor promoting oncogenesis. © 2005 Blackwell Publishing Asia Pty Ltd
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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: Masami Yoshiike, Naoto Egawa, 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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size location and patency of the Minor Duodenal Papilla as determined by dye injection endoscopic retrograde pancreatography
Digestive Endoscopy, 2001Co-Authors: Terumi Kamisawa, Naoto Egawa, Nobuhiro Sakaki, Junichi Ishiwata, Atsutake OkamotoAbstract:Background: The accessory pancreatic duct (APD) sometimes is developmentally obliterated near the duodenum. We evaluated patency of the Minor Duodenal Papilla by dye-injection endoscopic retrograde pancreatography to determine whether patency was related to Papillary size and location. Methods: We injected 2–3 mL of contrast material containing indigocarmine into the main pancreatic duct via an endoscopic catheter in 104 patients. It was endoscopically observed whether dye was extruded from the Minor Papilla. Size of the Minor Papilla and distance from the orifice of the major Duodenal Papilla to the apex of the Minor Papilla were measured endoscopically with measuring forceps. Results: The APD was patent in 56 of 104 cases (54%). Size of the Minor Papilla varied considerably from 3 to 6 mm, but showed no correlation with patency. Half of the patients with chronic pancreatitis (6/13) had the Minor Papilla larger than 6 mm. In cases where the terminal APD had a cudgel or tapering-off configuration, the Minor Papilla was larger than in cases where the duct had a stick shape. The Minor Papilla was patent in 9 out of 10 cases (90%) when it was near the major Papilla (≤ 1.5 cm). Frequency of a patent Minor Papilla was 16 out of 33 (48%) when it existed 1.5 to 2.0 cm from the major Papilla, and 31 out of 61 (51%) when the distance was more than 2.0 cm. Conclusions: The Minor Papilla was more frequently patent when it was close to the major Papilla (P < 0.05).
Atsutake Okamoto - One of the best experts on this subject based on the ideXlab platform.
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pancreatic tumor associated with pancreas divisum
Journal of Gastroenterology and Hepatology, 2005Co-Authors: Terumi Kamisawa, Masami Yoshiike, Atsutake Okamoto, Naoto Egawa, Kouji Tsuruta, Nobuaki FunataAbstract:Abstract Background: Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. Methods: A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal Papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum. Results: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal Papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma. Conclusions: Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the Minor Duodenal Papilla might be a factor promoting oncogenesis. © 2005 Blackwell Publishing Asia Pty Ltd
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size location and patency of the Minor Duodenal Papilla as determined by dye injection endoscopic retrograde pancreatography
Digestive Endoscopy, 2001Co-Authors: Terumi Kamisawa, Naoto Egawa, Nobuhiro Sakaki, Junichi Ishiwata, Atsutake OkamotoAbstract:Background: The accessory pancreatic duct (APD) sometimes is developmentally obliterated near the duodenum. We evaluated patency of the Minor Duodenal Papilla by dye-injection endoscopic retrograde pancreatography to determine whether patency was related to Papillary size and location. Methods: We injected 2–3 mL of contrast material containing indigocarmine into the main pancreatic duct via an endoscopic catheter in 104 patients. It was endoscopically observed whether dye was extruded from the Minor Papilla. Size of the Minor Papilla and distance from the orifice of the major Duodenal Papilla to the apex of the Minor Papilla were measured endoscopically with measuring forceps. Results: The APD was patent in 56 of 104 cases (54%). Size of the Minor Papilla varied considerably from 3 to 6 mm, but showed no correlation with patency. Half of the patients with chronic pancreatitis (6/13) had the Minor Papilla larger than 6 mm. In cases where the terminal APD had a cudgel or tapering-off configuration, the Minor Papilla was larger than in cases where the duct had a stick shape. The Minor Papilla was patent in 9 out of 10 cases (90%) when it was near the major Papilla (≤ 1.5 cm). Frequency of a patent Minor Papilla was 16 out of 33 (48%) when it existed 1.5 to 2.0 cm from the major Papilla, and 31 out of 61 (51%) when the distance was more than 2.0 cm. Conclusions: The Minor Papilla was more frequently patent when it was close to the major Papilla (P < 0.05).
Kenji Okubo - One of the best experts on this subject based on the ideXlab platform.
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a 12 mm carcinoid tumor of the Minor Duodenal Papilla with lymph node metastases
Japanese Journal of Clinical Oncology, 2013Co-Authors: Yasuyuki Fukami, Yasuhiro Kurumiya, Keisuke Mizuno, Ei Sekoguchi, Satoshi Kobayashi, Akira Ito, Akihiro Tomida, Sakura Onishi, Ryo Shirotsuki, Kenji OkuboAbstract:Carcinoid tumors located in the Minor Duodenal Papilla are extremely rare, with only a few cases reported in the literature. Herein, we report the case of a 71-year-old man with a 12-mm carcinoid tumor at the Minor Duodenal Papilla with lymph node metastases. Multidetector-row computed tomography with contrast enhancement revealed a 12-mm well-enhanced tumor in the duodenum. Upper gastrointestinal endoscopy showed a 12-mm submucosal tumor at the Minor Papilla of the duodenum. Biopsy specimens revealed a carcinoid tumor, and a subtotal stomach-preserving pancreatoduodenectomy was performed. Carcinoid tumors at the Minor Duodenal Papilla have a high prevalence of nodal disease, even for tumors <2 cm in diameter. Therefore, we believe that radical resection with tumor-free margins (i.e. pancreatoduodenectomy) is the treatment of choice.
Masami Yoshiike - One of the best experts on this subject based on the ideXlab platform.
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pancreatic tumor associated with pancreas divisum
Journal of Gastroenterology and Hepatology, 2005Co-Authors: Terumi Kamisawa, Masami Yoshiike, Atsutake Okamoto, Naoto Egawa, Kouji Tsuruta, Nobuaki FunataAbstract:Abstract Background: Although there has been considerable controversy regarding pancreas divisum and pancreatitis, little discussion of this has taken place. The purpose of the present paper was to investigate the relationship between these two conditions. Methods: A retrospective investigation was undertaken of pancreatic tumors associated with pancreas divisum, in 650 cases of pancreatic carcinoma, 80 cases of intraductal Papillary mucinous tumor of the pancreas and 32 cases of pancreas divisum. Results: Of these 32 cases, four (12.5%) were associated with pancreatic tumor: pancreatic carcinoma (n = 3) and intraductal Papillary mucinous tumor (n = 1). All tumors developed from the dorsal pancreas of pancreas divisum. Periductal and interlobular fibrosis detected in the non-carcinomatous pancreas of the margin of distal pancreatectomy implied that chronic dorsal pancreatitis associated with pancreas divisum preceded carcinoma. Conclusions: Pancreatic tumors were detected in 12.5% of cases of pancreas divisum. In pancreas divisum, longstanding pancreatic duct obstruction caused by relative stenosis of the Minor Duodenal Papilla might be a factor promoting oncogenesis. © 2005 Blackwell Publishing Asia Pty Ltd
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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: Masami Yoshiike, Naoto Egawa, 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.