PANCREAS ALERTS
Am J Gastroenterol 2002; 97(3):617-22.
Electronic pancreatoscopy for the diagnosis of pancreatic diseases.
Kodama T, Koshitani T, Sato H, Imamura Y, Kato K, Abe M, et al.
Department of Gastroenterology, Otsu Municipal Hospital, Shiga, Japan.
In this paper, the authors described diagnostic pancreatoscopy using the newly developed peroral electronic pancreatoscope.
Pancreatoscopy was performed using an endoscopic retrograde approach without sphincterotomy and the diagnostic value of this device for pancreatic diseases was evaluated in 56 patients.
The cases examined were 3 normal subjects, 32 with chronic pancreatitis, 8 having pancreatic cancer and 13 with intraductal papillary mucinous tumors.
Of the 56 cases, 42 (75%) were visualized with extreme clarity.
The authors concluded that electronic pancreatoscopy with a peroral electronic pancreatoscope is feasible in most patients, technically safe and improves diagnostic yield over conventional pancreatoscopy.
Gastrointest Endosc 2002; 55(4):494-9.
ERCP features in 27 patients with autoimmune pancreatitis.
Second Department of Internal Medicine and Department of Central Clinical Laboratory, Shinshu University School of Medicine, Matsumoto; Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan.
Autoimmune pancreatitis has been proposed as a new clinical entity and most of the present studies, especially those of Japanese and European researchers, have focused their attention on this disease.
In this paper, the authors report the clinical and radiographic features in 27 patients with a diagnosis of autoimmune pancreatitis and describe the endoscopic retrograde cholangiopancreatography features of this entity in detail.
From a clinical point of view, all 27 patients were first suspected of having pancreatic cancer. The patients were predominantly elderly men and presented with jaundice or mild symptoms and pancreatic enlargement, but no attack of acute pancreatitis.
The authors concluded that segmental or diffuse irregular narrowing of the main pancreatic duct are endoscopic retrograde cholangiopancreatographic features of autoimmune pancreatitis.
Gastrointest Endosc 2002; 55(4):507-11.
EUS in the diagnosis of early chronic pancreatitis: A prospective follow-up study.
Department of Gastroenterology and the Department of Surgery, Otto-von-Guericke-University, Magdeburg, Germany.
In this study the authors investigated the value of endoscopic ultrasonography in the diagnosis of alcohol-induced chronic pancreatitis in a prospective manner.
One hundred and thirty patients, 51 of them with known and 79 with clinically suspected chronic pancreatitis were included.
All patients with chronic pancreatitis confirmed by retrograde pancreatography (n = 92; 70.8%) had ductal or parenchymal changes detectable with endoscopic ultrasonography.
Thirty-eight patients with normal endoscopic retrograde pancreatography (29.2%) but with signs of chronic pancreatitis on endoscopic ultrasonography were included in a follow-up program; 32 (84.2%) presented morphologic features consistent with chronic pancreatitis at endoscopic ultrasonography.
In conclusion, the results of this study demonstrate that endoscopic ultrasonography detects chronic pancreatitis in all cases if endoscopic retrograde pancreatography suggested possible chronic pancreatitis.
This instrument has an external diameter of 2.1 mm and a bidirectional tip deflection, and was developed with a minute 50,000-pixel interline charge-coupled device.
In the normal subjects, fine capillary vessels were clearly visualized on the smooth whitish-pink mucosa.
The findings in those with chronic pancreatitis included protein plugs, calcified stones, rough whitish mucosa, scar formation, edema, erythema, and indistinct capillary appearance.
All the stenoses due to chronic pancreatitis could be differentiated from those due to pancreatic cancer.
All patients with pancreatic cancer had stenoses or duct cutoffs; most cases had friable mucosa with erythema and erosive changes, and a single patient had a compressed pancreatic duct wall covered with normal epithelium.
In the cases of those with intraductal papillary mucinous tumors, papillary tumors were visualized with extreme clarity.
In the case of adenocarcinoma, oval-shaped tumors with a spotty redness or villous tumors with dilation of the capillary vessels were revealed.
Moderate acute pancreatitis was recognized after pancreatoscopy in one of the 56 cases (1.8%).
Horiuchi A, Kawa S, Hamano H, Hayama M, Ota H, Kiyosawa K.
A cholestatic biochemical profile and serum IgG elevation were usually present.
A diffusely or segmentally irregular and narrow main pancreatic duct and a positive response to corticosteroid therapy were characteristic.
During observation without treatment, serial pancreatography in 2 patients demonstrated the progression of diffuse, irregular narrowing of the main pancreatic duct over periods of 2 and 6 months, respectively.
In response to corticosteroid therapy, both the irregular narrowing of the main pancreatic duct and the distal bile duct strictures improved to varying degrees.
Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P.
Patients with a history of chronic use of alcohol and recurrent abdominal pain underwent endoscopic retrograde pancreatography and endoscopic ultrasonography.
During follow-up (median 18 months, range 6-25 months), chronic pancreatitis was confirmed by repeat endoscopic retrograde pancreatography in 22 of these 32 patients (68.8%).
On the basis of these follow-up data, the sensitivities of endoscopic ultrasonography and endoscopic retrograde pancreatography at the time of the first examination were 100% and 80.7%, respectively (P<0.001).
However, endoscopic ultrasonography is more sensitive than endoscopic retrograde pancreatography in the detection of early morphologic changes of chronic pancreatitis in patients with abdominal pain and a history of chronic and continued ingestion of alcohol.