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Abdominal Radiology (New York) Aug 2020To evaluate the pancreatic duct cutoff sign in detecting pancreatic adenocarcinoma using CT and MRI.
PURPOSE
To evaluate the pancreatic duct cutoff sign in detecting pancreatic adenocarcinoma using CT and MRI.
METHODS
A retrospective analysis of patients with a pancreatic duct (PD) cutoff sign on CT or MRI from 2000 to 2019 was performed. The primary outcome measured was the presence or absence of a malignant pancreatic tumor. Variables evaluated included imaging characteristics of patients with a malignant versus non-malignant cause of duct cutoff and included PD size and PD-to-parenchyma ratio, contour abnormality, abnormal enhancement, diffusion abnormality, and upstream parenchymal atrophy.
RESULTS
Seventy-two patients (44:28 M:F, mean age 64 years) were identified with a PD cutoff sign. Fifty-eight percent (42/72) of these patients were diagnosed with malignancy, 62% (26/42) of whom were diagnosed with pancreatic ductal adenocarcinoma. In patients diagnosed with a non-malignant cause of duct cutoff, 37% (11/30) were diagnosed with chronic pancreatitis. Eighty-eight percent (37/42) of patients with malignant causes and 33% (10/30) of patients with non-malignant causes were noted to have an associated mass on imaging. The presence of contour abnormality, diffusion abnormality, or abnormal enhancement at the level of the pancreatic cutoff was significantly higher in patients with malignancy (p < 0.05). There was no difference between groups in location of the pancreatic duct cutoff, degree of pancreatic duct dilatation, PD-to-parenchyma ratio, or presence of upstream atrophy.
CONCLUSION
Abrupt cutoff of the pancreatic duct was associated with an increased likelihood of detecting malignancy. All patients who demonstrate this sign should undergo expedited workup with dedicated MRI and EUS with biopsy.
Topics: Adenocarcinoma; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Middle Aged; Pancreatic Ducts; Pancreatic Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 32444890
DOI: 10.1007/s00261-020-02582-8 -
Digestive Diseases and Sciences May 2021
Topics: Humans; Pancreatic Ducts; Pancreatic Fistula
PubMed: 32794056
DOI: 10.1007/s10620-020-06538-2 -
Digestive Endoscopy : Official Journal... May 2022Disconnected pancreatic duct syndrome (DPDS) frequently occurs in patients with acute necrotizing pancreatitis and resultant pancreatic fluid collection (PFC). We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Disconnected pancreatic duct syndrome (DPDS) frequently occurs in patients with acute necrotizing pancreatitis and resultant pancreatic fluid collection (PFC). We performed a systematic review and meta-analysis to evaluate outcomes of endoscopic ultrasound-guided treatment of PFCs according to the presence of DPDS.
METHODS
Using PubMed, Embase, and the Cochrane database, we identified clinical studies published until January 2021 with data comparing outcomes of endoscopic ultrasound-guided drainage of PFCs between DPDS and non-DPDS patients. We pooled data on technical and clinical success rates, PFC recurrence, and adverse events using the random-effects model.
RESULTS
We identified five eligible articles including 941 PFC patients treated with endoscopic ultrasound-guided interventions. Clinical success, defined as resolution of the PFC and symptoms, was achieved in a majority of the cases irrespective of DPDS (pooled odds ratio [OR] comparing DPDS to non-DPDS patients, 0.77; 95% confidence interval [CI] 0.33-1.81). Compared to patients without DPDS, patients with DPDS were more likely to undergo PFC recurrence (pooled OR 6.72; 95% CI 2.72-16.6) after clinical resolution of PFC. Prolonged plastic stent placement following the clinical resolution was more frequently performed in DPDS patients than in non-DPDS patients (pooled OR 15.9; 95% CI 2.76-91.9). No statistically significant difference was observed between the groups in terms of the rate of technical success, adverse events, or mortality.
CONCLUSION
Disconnected pancreatic duct syndrome was associated with higher rate of PFC recurrence after successful endoscopic treatment of PFCs. Future studies should evaluate effectiveness and optimal duration of long-term placement of transmural plastic stents for PFCs with DPDS.
Topics: Drainage; Endosonography; Humans; Pancreatic Ducts; Pancreatitis, Acute Necrotizing; Plastics; Retrospective Studies; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 34544204
DOI: 10.1111/den.14142 -
Gastrointestinal Endoscopy Jun 2023
Topics: Humans; Constriction, Pathologic; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Ducts; Gastrointestinal Diseases
PubMed: 36623573
DOI: 10.1016/j.gie.2023.01.003 -
Surgical and Radiologic Anatomy : SRA Sep 2022Anatomical variations of the pancreas are relatively frequent and often understudied. The ductal system of the pancreas has multiple variations, which are not frequently...
PURPOSE
Anatomical variations of the pancreas are relatively frequent and often understudied. The ductal system of the pancreas has multiple variations, which are not frequently reported in the literature.
MATERIALS AND METHODS
The anatomy of the pancreas was studied through macroscopic anatomical dissection on 50 organ complexes (the pancreas, spleen, and duodenum) donated to the department of human anatomy, from patients, who died of causes not related to pancreatic diseases.
RESULTS
In type I, the main pancreatic duct (Wirsung's duct, MPD) and the accessory pancreatic duct (Santorini's duct, APD) were merged but most of the head was drained by the MPD (10% of cases). In type II, the MPD and APD were merged but most of the head was drained by the APD (4% of cases). In type III, the APD was absent and the head was drained by the MPD (14% of cases). In type IV, there was an inverted pancreas divisum where the ducts did not merge but each drained a part of the head (6% of cases). Classical pancreas divisum where the ducts did not merge but each drained a part of the head was considered as type V (4% of cases). In type VI, the MPD and APD merged and each drained a part of the head (48% of cases). In type VII, the MPD and APD merged but the upper part of the head was drained by the main pancreatic duct (4% of cases). In type VIII, the MPD and APD merged but the lower part of the head was drained by the main pancreatic duct (4% of cases). In the IX type, the MPD and APD merged but the head was drained by the branches of the MPD (6% of cases).
CONCLUSIONS
There are several drainage patterns of the pancreas. In some cases, one of the ducts provides more drainage of the gland than the other. This is clinically relevant since blockage of the main source of drainage leads to pancreatic juice stasis. It also explains cases when partial or total blockage of the duct results in the pancreatitis of an isolated zone.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis
PubMed: 35986117
DOI: 10.1007/s00276-022-03002-w -
Gut Sep 2023Changes of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper...
OBJECTIVE
Changes of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper reference ranges are missing.
DESIGN
Cross-sectional whole body MRI data from the population-based Study of Health in Pomerania were analysed. The width of the common bile duct (CBD) and the pancreatic duct (PD) was determined. We aimed to describe the distribution of physiological duct diameters on MRCP in a population of healthy subjects and to identify factors influencing duct size.
RESULTS
After excluding pre-existing pancreaticobiliary conditions, CBD and PD diameters from 938 and 774 healthy individuals, respectively, showed a significant increase with age (p<0.0001) and exceeded the conventional upper reference limit of normal in 10.9% and 18.2%, respectively. Age-dependent upper reference limits of duct diameters were delineated with non-parametric quantile regression, defined as 95th percentile: for CBD up to 8 mm in subjects <65 years and up to 11 mm in subjects ≥65 years. For the PD reference diameters were up to 3 mm in subjects <65 years and up to 4 mm in subjects ≥65 years.
CONCLUSIONS
This is the first population-based study delineating age-adjusted upper reference limits of CBD and PD on MRCP. We showed that up to 18.2% of healthy volunteers would have needed diagnostic workup, if the conventional reference values were used. The utilisation of the adapted reference levels may help to avoid unnecessary investigations and thus to reduce healthcare expenditure and test-related adverse events.
Topics: Humans; Aged; Cholangiopancreatography, Magnetic Resonance; Reference Values; Cross-Sectional Studies; Pancreatic Ducts; Common Bile Duct; Cohort Studies
PubMed: 36828626
DOI: 10.1136/gutjnl-2021-326106 -
Current Opinion in Gastroenterology Sep 2018To provide an overview of the field of pancreatoscopy and to summarize the data informing its clinical utility.
PURPOSE OF REVIEW
To provide an overview of the field of pancreatoscopy and to summarize the data informing its clinical utility.
RECENT FINDINGS
Regarding the technological advance of pancreatoscopy, recent studies are the first to report the use of digital, single-operator pancreatoscopy (SpyGlass DS; Boston Scientific, Natick, MA). New data on the use of preoperative pancreatoscopy offer promising results for the potential to optimize treatment of intraductal papillary mucinous neoplasms and to differentiate between benign and malignant pancreatic strictures. Finally, there has been accumulating evidence for the use of pancreatoscopy-guided lithotripsy for the management of painful chronic calcific pancreatitis.
SUMMARY
Endoscopic pancreatoscopy offers the advantage of direct visualization of the pancreatic duct, allowing for optimal macroscopic assessment, targeted tissue acquisition and guided therapies such as lithotripsy of pancreatic duct stones. The data informing some aspects remain limited, but the accumulating literature forms our understanding of the current and future role of pancreatoscopy in the management of pancreatic disease.
Topics: Endoscopy, Digestive System; Humans; Pancreatic Diseases; Pancreatic Ducts
PubMed: 29847323
DOI: 10.1097/MOG.0000000000000453 -
Gastrointestinal Endoscopy Feb 2018
Topics: Constriction, Pathologic; Humans; Pancreas; Pancreatic Ducts; Stents
PubMed: 29406931
DOI: 10.1016/j.gie.2017.11.004 -
Medicine Aug 2023Laparoscopic pancreaticoduodenectomy (LPD) is a classic surgical method for diseases, such as tumors at the lower end of the common bile duct, pancreatic head, and...
Laparoscopic pancreaticoduodenectomy (LPD) is a classic surgical method for diseases, such as tumors at the lower end of the common bile duct, pancreatic head, and benign and malignant tumors of the duodenum. Postoperative pancreatic fistula (POPF) is one of the most serious complications of LPD. To reduce the incidence of grade B or C POPF and other complications after LPD, we applied a split pancreatic duct stent combined with the characteristics of internal and external stent drainage. Between September 2020 and September 2022,12 patients underwent placement of the Split pancreatic duct stent during LPD. Data on basic characteristics of patients, surgical related indicators and postoperative POPF incidence were collected and analyzed. The results showed that the average operation time was 294.2 ± 36 minutes, average time for pancreaticojejunostomy was 35.9 ± 4.1 minutes, and average estimated blood loss was 204.2 ± 58.2 mL. Biochemical leakage occurred in 2 patients (16.7%), whereas no grade B or C POPF, 1 case (8.3%) had postoperative bleeding, and no death occurred within 30 days after the operation. Preliminary experience shows that the split pancreatic duct stent can effectively reduce the incidence of complications after LPD, especially grade B or C POPF.
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Ducts; Pancreas; Pancreaticojejunostomy; Pancreatic Fistula; Postoperative Complications; Laparoscopy; Stents; Retrospective Studies
PubMed: 37543786
DOI: 10.1097/MD.0000000000034049 -
Digestive Diseases and Sciences Feb 2024Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous... (Review)
Review
Pancreatic fistula is a highly morbid complication of pancreatitis. External pancreatic fistulas result when pancreatic secretions leak externally into the percutaneous drains or external wound (following surgery) due to the communication of the peripancreatic collection with the main pancreatic duct (MPD). Internal pancreatic fistulas include communication of the pancreatic duct (directly or via intervening collection) with the pleura, pericardium, mediastinum, peritoneal cavity, or gastrointestinal tract. Cross-sectional imaging plays an essential role in the management of pancreatic fistulas. With the help of multiplanar imaging, fistulous tracts can be delineated clearly. Thin computed tomography sections and magnetic resonance cholangiopancreatography images may demonstrate the communication between MPD and pancreatic fluid collections or body cavities. Endoscopic retrograde cholangiography (ERCP) is diagnostic as well as therapeutic. In this review, we discuss the imaging diagnosis and management of various types of pancreatic fistulas with the aim to sensitize radiologists to timely diagnosis of this critical complication of pancreatitis.
Topics: Humans; Pancreatic Fistula; Cholangiopancreatography, Endoscopic Retrograde; Pancreatitis; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Magnetic Resonance Imaging
PubMed: 38114791
DOI: 10.1007/s10620-023-08173-z