Possibility of diagnosing early-stage chronic pancreatitis by endoscopic retrograde pancreatography

Abstract

Background: It has been proposed that pathological lesions in chronic pancreatitis initially arise in the acini or fine ducts of the pancreas. To investigate the possibility of diagnosing early-stage chronic pancreatitis by endoscopic retrograde pancreatography (ERP), we reviewed pancreatographic findings of the pancreatic duct branches in patients with chronic pancreatitis.

Methods: A total of 90 cases of chronic pancreatitis (calcified, n=52; noncalcified, n=38) were reassessed according to the imaging of the pancreatic duct branches by ERP. Degree of irregular dilatation of the pancreatic duct branches was classified into three grades: severe, moderate, and mild. We also reviewed pancreatographic findings of 57 patients with chronic pancreatitis who had undergone ERP on more than two occasions at intervals of at least 1 year.

Results: Severe irregular dilatation of the pancreatic duct branches was detected more frequently in cases of calcified chronic pancreatitis than in those of noncalcified chronic pancreatitis (P<0.01). Histology of the pancreas showing exclusively dilatation of the pancreatic duct branches without dilatation of the main pancreatic duct showed interlobular fibrosis without marked destruction of the acini. In serial pancreatography, segmental abnormalities of the pancreatic duct at the body or tail of the pancreas spread to the head of the pancreas in eight cases.

Conclusions: Irregular dilatation of the pancreatic duct branches or segmental ductal changes in the pancreatic body or tail might indicate early-stage chronic pancreatitis.