title: Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis.
abstract: The integrity of the main pancreatic duct (MPD) was evaluated by endoscopic retrograde pancreatography (ERP) in a retrospective study of 105 patients with acute pancreatitis presenting over an 11-year period (1980-1991). The findings were compared with clinical outcome and the need to operate for local pancreatic complications. Patients were divided into two groups. Group 1 (n = 89) had either clinically mild pancreatitis or severe disease but no surgery for local complications, and < 25 per cent necrosis on contrast-enhanced computed tomography (CT) (n = 48). Group 2 patients (n = 16) had clinically severe pancreatitis and underwent surgery for local complications and/or had > or = 25 per cent necrosis on CT (n = 12), at surgery or post mortem. All 89 patients in group 1 had an intact MPD at ERP, which was performed a median of 6 (range 0-30) days after onset of pancreatitis; the median age was 63 (range 20-88) years and there were no deaths. The median age of patients in group 2 was 59 (range 26-85) years. ERP in this group was performed in four patients < 5 days after onset and all had an intact MPD; one died with necrosis and another from a cerebrovascular accident. ERP was performed > or = 5 days after onset in the other 12 patients; five had an intact MPD and two required surgery for pseudocyst drainage only; seven had a disrupted MPD and all required surgery for pancreatic necrosis (one death). It is concluded that an intact MPD was a feature of mild pancreatitis, whereas disruption occurred > 4 days after onset in patients with necrosis necessitating surgery.
authors.affiliation: Academic Department of Surgery, Dudley Road Hospital, Birmingham, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: N J
authors.initials: NJ
authors.lastname: London
authors.forename: D L
authors.initials: DL
authors.lastname: Carr-Locke
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000473:pathology; D012017:Referral and Consultation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed