Charles A. Rohrmann

Evaluation of the Endoscopic Pancreatogram

Of 300 endoscopic attempts at cannulation of the biliary and/or pancreatic ducts, 265 were successful and pancreatograms obtained in 203. The duct of clinical interest was visualized in 67% of the initial 150 studies and in 93% of the rest. In 75 proved cases of pancreatic disease, the pancreatographic features of the following disorders were identified: (a) Acute recurrent pancreatitis: 66% of these studies were normal. (b) Chronic pancreatitis: 93% of these were abnormal. (c) Pancreatic cyst: consistently abnormal studies were seen, with filling of the cyst cavity in 62%. (d) Pancreatic neoplasm: abnormal studies were demonstrated in 74% of cases. With use of combined ductal characteristics, the ultimate diagnosis can be suggested in most of these cases.

The Normal Endoscopic Pancreatogram

Pancreatograms of 102 patients with proved normal pancreatic status were reviewed to establish normal standards of pancreatic ductal morphology, and precise details of ductal course, position, length, caliber, and variant anatomy were analyzed. The ampulla was found at the level of the second lumbar vertebra in 75% of cases, while the pancreatic duct crossed the spine at L1 in most cases. Mean ductal diameters were 3.1, 2.0 and 0.9 mm in the head, body, and tail of the pancreas, respectively.

The Significance of Pancreatic Ductal Obstruction in Differential Diagnosis of the Abnormal Endoscopic Retrograde Pancreatogram

Apparent obstruction of the main pancreatic duct was seen on the endoscopic retrograde pancreatogram in 50 patients. The final diagnosis was pseudocyst in 15, neoplasm in 15, chronic pancreatitis in 8, acute recurrent pancreatitis in 3, and abscess in 2. Seven patients were normal. This series emphasizes the broad differential approach necessary when confronted with ductal obstruction. Diagnosis is facilitated by accurate evaluation of the ductal and extraductal characteristics, especially the ductal detail at the point of termination.