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American Journal of Veterinary Research Mar 2013To obtain ultrasonographic reference values for the thickness of the pancreas and the diameter of the pancreatic duct in clinically normal dogs.
OBJECTIVE
To obtain ultrasonographic reference values for the thickness of the pancreas and the diameter of the pancreatic duct in clinically normal dogs.
ANIMALS
242 adult dogs with no clinical signs of gastrointestinal tract disease.
PROCEDURES
The maximum pancreatic thickness and the diameter of the pancreatic duct were recorded ultrasonographically at the level of the left lobe, body, and right lobe of the pancreas.
RESULTS
Mean ± SD pancreatic thickness measurements were as follows: left lobe, 6.5 ± 1.7 mm (n = 214); body, 6.3 ± 1.6 mm (155); and right lobe, 8.1 ± 1.8 mm (239). The mean pancreatic duct diameter was 0.6 ± 0.2 mm (n = 42) in the left lobe and 0.7 ± 0.2 mm (213) in the right lobe. The right pancreatic duct was visible in 213/242 (88.0%) dogs, and the left pancreatic duct was visible in 41/242 (16.9%) dogs. However, the body was visible in only 16/242 (6.6%) dogs. Pancreatic thickness and diameter of the pancreatic duct significantly increased with body weight in all lobes, but age was not correlated with the measurements.
CONCLUSIONS AND CLINICAL RELEVANCE
Ultrasonographic reference values for the pancreas and pancreatic duct of dogs were determined. Results of this study indicated that the pancreatic duct was visible, especially in the right lobe of the pancreas. These values may be useful for the assessment of pancreatic abnormalities, such as chronic pancreatitis and exocrine pancreatic insufficiency.
Topics: Animals; Dogs; Female; Male; Pancreas; Pancreatic Ducts; Prospective Studies; Reference Values; Statistics, Nonparametric; Ultrasonography
PubMed: 23438119
DOI: 10.2460/ajvr.74.3.433 -
PloS One 2022Three-dimensional surgical simulation, already in use for hepatic surgery, can be used in pancreatic surgery. However, some problems still need to be overcome to achieve...
Three-dimensional surgical simulation, already in use for hepatic surgery, can be used in pancreatic surgery. However, some problems still need to be overcome to achieve more precise pancreatic surgical simulation. The present study evaluates the performance of SYNAPSE VINCENT® (version 6.6, Fujifilm Medical Co., Ltd., Tokyo, Japan) in the semiautomated surgical simulation of the pancreatic parenchyma, pancreatic ducts, and peripancreatic vessels using an artificial intelligence (AI) engine designed with deep learning algorithms. One-hundred pancreatic cancer patients and a control group of 100 nonpancreatic cancer patients were enrolled. The evaluation methods for visualizing the extraction were compared using the Dice coefficient (DC). In the pancreatic cancer patients, tumor size, position, and stagewise correlations with the pancreatic parenchymal DC were analyzed. The relationship between the pancreatic duct diameter and the DC, and between the manually and AI-measured diameters of the pancreatic duct were analyzed. In the pancreatic cancer/control groups, the pancreatic parenchymal DC and pancreatic duct extraction were 0.83/0.86 and 0.84/0.77. The DC of the arteries (portal veins/veins) and associated sensitivity and specificity were 0.89/0.88 (0.89/0.88), 0.85/0.83 (0.85/0.82), and 0.82/0.81 (0.84/0.81), respectively. No correlations were observed between pancreatic parenchymal DC and tumor size, position, or stage. No correlation was observed between the pancreatic duct diameter and the DC. A positive correlation (r = 0.61, p<0.001) was observed between the manually and AI-measured diameters of the pancreatic duct. Extraction of the pancreatic parenchyma, pancreatic duct, and surrounding vessels with the SYNAPSE VINCENT® AI engine assumed to be useful as surgical simulation.
Topics: Humans; Deep Learning; Artificial Intelligence; Pancreatic Ducts; Pancreatic Neoplasms; Algorithms
PubMed: 36306322
DOI: 10.1371/journal.pone.0276600 -
Digestive Surgery 2010The minor duodenal papilla, which is the orifice of the accessory, or dorsal, pancreatic duct/Santorini duct, mostly accompanied by pancreatic tissue, is situated about... (Review)
Review
The minor duodenal papilla, which is the orifice of the accessory, or dorsal, pancreatic duct/Santorini duct, mostly accompanied by pancreatic tissue, is situated about 2 cm ventroproximal to the major duodenal papilla. The patency of the terminal accessory pancreatic duct (APD) is recognized in about half or more of cases, and is related to the degree of fibrosis. The APD is lined with simple columnar epithelium and encircled by a smooth muscle layer. It is still controversial whether or not these muscle tissues comprise a sphincter muscle. Pancreatic tissue was found in about 80% of cases in the minor papilla. Among these cases, pancreatic tissue was continuous and/or closely related to the proper pancreas in about 40% of cases, and might have the same exocrine and endocrine morphologies/functions, suggesting that it is a portion of the dorsal pancreas and not an ectopic one. Endocrine cell micronests are frequently found in the ductal wall/surrounding area of the terminal APD, and predominantly consist of somatostatin- and/or pancreatic-polypeptide-containing cells. In cases of pancreas divisum, inadequate pancreatic juice drainage from the minor papilla might occur, resulting in dorsal pancreatitis. In the minor papilla, all ductal tumors may occur, such as an intraductal papillary mucinous neoplasms and invasive ductal carcinoma, but carcinoid tumors are rare.
Topics: Ampulla of Vater; Enteroendocrine Cells; Humans; Pancreas; Pancreatic Ducts; Pancreatic Neoplasms
PubMed: 20551659
DOI: 10.1159/000286920 -
Gastrointestinal Endoscopy Feb 2021EUS and endoscopic pancreatic function tests (ePFTs) may be used to diagnose minimal-change chronic pancreatitis (MCCP). The impact of evaluation for exocrine pancreatic... (Clinical Trial)
Clinical Trial
BACKGROUND AND AIMS
EUS and endoscopic pancreatic function tests (ePFTs) may be used to diagnose minimal-change chronic pancreatitis (MCCP). The impact of evaluation for exocrine pancreatic insufficiency (EPI) and real-time assessment of EUS changes after intravenous secretin on the clinical diagnosis of MCCP is unknown.
METHODS
Patients with suspected MCCP underwent baseline EUS assessment of the pancreatic parenchyma and measurement of the main pancreatic duct (B-MPD) in the head, body, and tail. Human secretin 0.2 μg/kg was given intravenously followed 4, 8, and 12 minutes later by repeat MPD (S-MPD) measurements. Duodenal samples at 15, 30, and 45 minutes were aspirated to assess bicarbonate concentration. Endoscopists rated the percentage clinical likelihood of chronic pancreatitis (1) before secretin; (2) after secretin but before aspiration; and (3) after bicarbonate results.
RESULTS
A total of 145 consecutive patients (mean age, 44±13 years; 98 females) were diagnosed with EPI (n = 32; 22%) or normal exocrine pancreatic function (n = 131, 78%). S-MPD/B-MPD ratios in the tail 4 and 8 minutes after secretin were higher in the group with normal exocrine function. Ratios at other times, locations, and duodenal fluid volumes were similar between the 2 groups. A statistically significant change in the median percentage likelihood of chronic pancreatitis was noted after secretin in all groups. The sensitivity and specificity of EPI for the EUS diagnosis of chronic pancreatitis (≥5 criteria) were 23.4% (95% confidence interval, 12.3-38.0) and 78.6% (95% confidence interval, 69.1-86.2), respectively.
CONCLUSION
Real-time EUS findings and ePFTs have a significant impact on the clinical assessment of MCCP. The diagnosis of EPI shows poor correlation with the EUS diagnosis of MCCP. (Clinical trial registration number: NCT01997476.).
Topics: Adult; Endosonography; Exocrine Pancreatic Insufficiency; Female; Humans; Middle Aged; Pancreatic Ducts; Pancreatic Function Tests; Pancreatitis, Chronic
PubMed: 32562609
DOI: 10.1016/j.gie.2020.06.029 -
Canadian Journal of Gastroenterology &... 2019The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was... (Observational Study)
Observational Study
BACKGROUND AND AIMS
The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention.
METHODS
This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW.
RESULTS
The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22-0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30-0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61-8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09-0.85, P = 0.02).
CONCLUSIONS
Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.
Topics: Adult; Aged; Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Equipment Design; Female; Humans; Male; Middle Aged; Pancreatic Ducts; Pancreatitis; Patient Safety; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult
PubMed: 31058112
DOI: 10.1155/2019/8947614 -
World Journal of Gastroenterology Mar 2011Non-cirrhotic portal hypertension (PHT) accounts for about 20% of all PHT cases, portal vein thrombosis (PVT) resulting in cavernous transformation being the most common... (Review)
Review
Non-cirrhotic portal hypertension (PHT) accounts for about 20% of all PHT cases, portal vein thrombosis (PVT) resulting in cavernous transformation being the most common cause. All known complications of PHT may be encountered in patients with chronic PVT. However, the effect of this entity on the biliary tree and pancreatic duct has not yet been fully established. Additionally, a dispute remains regarding the nomenclature of common bile duct abnormalities which occur as a result of chronic PVT. Although many clinical reports have focused on biliary abnormalities, only a few have evaluated both the biliary and pancreatic ductal systems. In this review the relevant literature evaluating the effect of PVT on both ductal systems is discussed, and findings are considered with reference to results of a prominent center in Turkey, from which the term "portal ductopathy" has been put forth to replace "portal biliopathy".
Topics: Bile Duct Diseases; Bile Ducts; Humans; Pancreatic Ducts; Portal Vein; Prognosis; Terminology as Topic; Venous Thrombosis
PubMed: 21472098
DOI: 10.3748/wjg.v17.i11.1410 -
JOP : Journal of the Pancreas May 2012Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in... (Review)
Review
Pancreas divisum is the most common congenital anatomic variation of the pancreatic ductal anatomy and in most of the individuals it is asymptomatic. However, in minority of individuals it is presumed to cause recurrent acute pancreatitis and chronic pancreatitis. Endoscopic retrograde cholangiopancreatography is the gold standard for its diagnosis, but is invasive and associated with significant adverse effects. Endoscopic ultrasound (EUS) allows the detailed evaluation of the pancreaticobiliary ductal system without injecting contrast in these ducts. Moreover, it provides detailed images of the parenchyma also. Therefore EUS, both radial and linear, has potential for being a minimally invasive diagnostic modality for pancreas divisum. A number of EUS criteria have been suggested for the diagnosis of pancreas divisum. These criteria have varying sensitivity and specificity and hence there is a need for objective and uniform criteria that have the best diagnostic accuracy. Secretin EUS has a potential for diagnosing minor papilla stenosis and thus help in planning appropriate therapy. EUS guided pancreatic duct interventions can help in draining dorsal duct in symptomatic patients with failed minor papilla cannulation. But these techniques are technically demanding and associated with potential severe complications.
Topics: Congenital Abnormalities; Drainage; Endosonography; Humans; Pancreatic Ducts; Pancreatitis; Recurrence; Sensitivity and Specificity
PubMed: 22572127
DOI: No ID Found -
Korean Journal of Radiology 2013Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients,... (Review)
Review
Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.
Topics: Cholangiopancreatography, Magnetic Resonance; Humans; Multidetector Computed Tomography; Pancreas; Pancreatic Diseases; Pancreatic Ducts
PubMed: 24265565
DOI: 10.3348/kjr.2013.14.6.905 -
Digestive Surgery 2013Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Several studies suggested that pancreatic stents had some benefit during pancreatoduodenectomy (PD), but others disagree. Whether pancreatic duct stents could prevent postoperative pancreatic fistula (POPF) is still under controversy.
METHODS
Randomized controlled trials published before November 2012 were all aggregated, focusing on the evaluation of pancreatic duct stents during PD. Trial data was reviewed and extracted independently by two reviewers. The quality of the including studies was assessed by the Cochrane handbook 5.1.0.
RESULTS
Seven studies were included, with a total of 793 patients. The results showed that compared with nonstents, stents during PD was associated with a significant difference on overall POPF rate (OR = 0.65, 95% CI 0.45-0.95, p = 0.02), POPF grades B and C (OR = 0.45, 95% CI 0.27-0.76, p = 0.003), and hospital stay (MD = -4.28, 95% CI -6.81, -1.75, p = 0.0009). Subgroup analyses showed that the external stent had a significant difference in the incidence of overall POPF (OR = 0.46, 95% CI 0.29-0.73, p = 0.0009), POPF grades B and C (OR = 0.49, 95% CI 0.30-0.79, p = 0.003), postoperative morbidity (OR = 0.63, 95% CI 0.42-0.96, p = 0.03), as well as hospital stay.
CONCLUSIONS
Based upon this meta-analysis, there might be potential benefit in reducing POPF thanks to the use of pancreatic duct stents.
Topics: Anastomosis, Surgical; Humans; Length of Stay; Pancreatic Ducts; Pancreaticoduodenectomy; Research Design; Stents; Survival Analysis; Treatment Outcome
PubMed: 24217416
DOI: 10.1159/000355982 -
Diabetologia Jan 2010In a high-fat-fed rat model of type 2 diabetes we noted increased exocrine duct replication. This is a predisposing factor for pancreatitis and pancreatic cancer, both...
AIMS/HYPOTHESIS
In a high-fat-fed rat model of type 2 diabetes we noted increased exocrine duct replication. This is a predisposing factor for pancreatitis and pancreatic cancer, both of which are more common in type 2 diabetes. The aim of the study reported here was to establish if obesity and/or type 2 diabetes are associated with increased pancreatic ductal replication in humans.
METHODS
We obtained pancreas at autopsy from 45 humans, divided into four groups: lean (BMI <25 kg/m(2)); obese (BMI >27 kg/m(2)); non-diabetic; and with type 2 diabetes. Pancreases were evaluated after immunostaining for the duct cell marker cytokeratin and Ki67 for replication.
RESULTS
We show for the first time that both obesity and type 2 diabetes in humans are associated with increased pancreatic ductal replication. Specifically, we report that (1) replication of pancreatic duct cells is increased tenfold by obesity, and (2) lean subjects with type 2 diabetes demonstrate a fourfold increase in replication of pancreatic duct cells compared with their lean non-diabetic controls.
CONCLUSIONS/INTERPRETATION
Pancreatic duct cell replication is increased in humans in response to both obesity and type 2 diabetes, potentially providing a mechanism for the increased risk of pancreatitis and pancreatic cancer in those with obesity and/or type 2 diabetes.
Topics: Aged; Aged, 80 and over; Animals; Autopsy; Body Mass Index; Cell Division; Diabetes Mellitus, Type 2; Disease Models, Animal; Female; Humans; Male; Middle Aged; Obesity; Pancreatic Ducts; Rats
PubMed: 19844672
DOI: 10.1007/s00125-009-1556-8