title: Clinical significance of the accessory pancreatic duct.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 113-8677 Tokyo, Japan. kamisawa-k@komagome-hospital.bunkyo.tokyo.jp
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Egawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sakaki
authors.forename: Kouji
authors.initials: K
authors.lastname: Tsuruta
authors.forename: Atsutake
authors.initials: A
authors.lastname: Okamoto
mesh_terms: D000208:Acute Disease; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000503:physiopathology; D000681:Amylases / Q000378:metabolism; D001646:Bile / Q000201:enzymology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage; D004384:Duodenoscopy; D006801:Humans; D006874:Hydrostatic Pressure; D007203:Indigo Carmine; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000503:physiopathology; D010189:Pancreatic Juice; D010195:Pancreatitis / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D012016:Reference Values
chemical_list: D003287:Contrast Media; D007203:Indigo Carmine; D000681:Amylases