Rationale and Objectives
A lack of pancreatic duct compliance and decreased duodenal filling on secretin-stimulated magnetic resonance cholangiopancreatography (s-MRCP) has been noted in patients with chronic pancreatitis. Whether endoscopic sphincterotomy can affect pancreatic duct compliance and duodenal filling on diagnostic s-MRCP is unknown.
Materials and Methods
A retrospective review of patients referred to the authors’ clinic from December 2006 to December 2007 was performed. Those patients with no evidence of chronic pancreatitis who underwent s-MRCP were studied. Findings on s-MRCP were analyzed, specifically noting change in pancreatic duct diameter size from baseline to maximum dilation and duodenal filling after secretin administration (0.2 μg/kg intravenous dose of human secretin).
Results
Of the 34 patients studied, 12 underwent endoscopic sphincterotomy, and 22 had intact sphincters of Oddi. In the sphincterotomy group, there was a mean change of 0.2 cm (range, 0.0–0.4 cm), while in the nonsphincterotomy group, the mean change was 0.9 cm (range, 0.3–2.0 cm) after secretin administration. The difference was significant ( P < .005).
Conclusion
Endoscopic sphincterotomy significantly decreases pancreatic duct dilation in response to secretin on s-MRCP. However, further studies are required to determine the effect sphincterotomy has on the amount of duodenal filling and the rate at which duodenal filling occurs.
The diagnosis of chronic pancreatitis is based on the evaluation of both functional and structural characteristics of the pancreas. On secretin-stimulated magnetic resonance cholangiopancreatography (s-MRCP), both pancreatic exocrine function and pancreatic ductal morphology can be evaluated ( ), the former of which is indirectly determined on s-MRCP by the degree of duodenal filling immediately after secretin stimulation. Although standard MRCP without secretin stimulation can assess pancreatic ductal morphology according to the Cambridge classification, small side-branch ectasia may not be seen without exocrine stimulation of the gland . Thus, better visualization of ectatic side branches after secretin stimulation may increase confidence in the diagnosis of chronic pancreatitis.
In recent years, investigators have noted that changes in the main pancreatic duct in response to secretin can also suggest the presence or absence of chronic pancreatitis . Most notably, these same investigators reported that in patients with chronic pancreatitis, there is limited secretin-stimulated dilatation of the pancreatic duct (compliance), compared to normal controls, and that the time to reach maximal pancreatic duct diameter is prolonged, suggesting that fibrosis in the gland may prohibit the pancreatic duct from having normal compliance.
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Materials and methods
Patient Population
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Magnetic Resonance Imaging Technique
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Image Analysis
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Parameters Analyzed
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Statistical Analysis
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Results
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Table 1
Patient Demographics
Variable Group 1 Group 2 Number of patients 22 12 Mean age (y) 44 48.5 Men/women 9/13 3/9 Sphincterotomy 0 12 (8 D, 4 B)
B, biliary sphincterotomy only; D, dual sphincterotomy.
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Pancreatic Duct
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Table 2
Pancreatic Duct Compliance After Secretin
Variable Group 1 Group 2 Absolute change in pancreatic duct diameter (cm) ∗ 0.9 (0.3–2.0) 0.2 (0.0–0.4) Percentage change in pancreatic duct diameter ∗ 60% (13%–123%) 10% (1%–38%) Time to reach maximal pancreatic duct diameter (min) 5.6 (3–17) 5.3 (1–10) Mean pancreatic duct diameter at peak (cm) 2.45 2.04 Duodenal filling at peak pancreatic duct diameter 1.5 (0–3) 1.8 (0–3) Time to maximal duodenal filling (min) 8.0 6.4
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Duodenal Filling
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Discussion
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