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Query: UMLS:C0149521 (chronic pancreatitis)
 7,199 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The value of endoscopic retrograde cholangiopancreaticography (ERCP) for establishing the indication for surgery and for planning surgical procedures is discussed. The two most widely practiced methods of direct cholangiography - percutaneous transhepatic and endoscopic retrograde cholangiography (PTC and ERC) - are compared: although the filling rate with ERC is slightly lower than with PTC, the endoscopic method has some important advantages as it allows endoscopic observation and biopsy of the duodenum. Furthermore, opacification of the pancreatic duct system often provides important additional information. ERCP is essentially important in post-cholecystectomy syndrome, as puncture of undilated bile ducts is difficult and persistent symptoms after cholecystectomy are not infrequently related to pancreatic disease. The importance of rapid surgical intervention after retrograde filling of the biliary tree in obstructive jaundice is stressed. In pancreatic diseases the indication for surgery is based mainly on clinical and laboratory findings. Differentiation of malignant and inflammatory changes in the pancreaticogram is still a problem. However, the contribution of ERCP to pancreatic surgery is very important, as it exactly localized lesions of the pancreas and therefore allows detailed planning of a surgical procedure. Stenosing or obstructing lesions often are an indication for surgery, even if their malignant nature is not certain, as severe pain in chronic pancreatitis may be relieved by surgery. The potential for therapeutic application of endoscopy in biliary and pancreatic diseases is briefly discussed.
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PMID:[The value of endoscopic retrograde cholangiopancreaticography for the surgery of bile duct and pancreatic diseases]. 121 73

Bronchobiliary fistulas are rare. One aetiological cause is biliary obstruction with secondary suppuration and subsequent hepatic and subphrenic abscesses. Only a few cases of bronchobiliary fistulas in patients with chronic pancreatitis have been reported and we record another case. A 47-year-old white male, with chronic alcohol-induced pancreatitis who had earlier undergone several laparotomies related to this disease, was admitted with a hepatic abscess. Drainage was not successful. The patient developed bilioptysis and a bronchobiliary fistula was diagnosed. The fistulous tract was demonstrated using PTC as well as bronchography. Laparotomy was performed and the fistulous tract was excised. The hepaticoduodenal ligament was completely obstructed by the inflamed pancreatic gland. An earlier but now obstructed cholecystojejunostomy was revised. This case was complicated by episodes of severe gastrointestinal bleeding probably caused by thrombosis of the portal vein and local varices around the gallbladder and common duct.
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PMID:Bronchobiliary fistula in chronic pancreatitis. Case report. 367 59

Biliary obstruction by non-malignant lesions can be treated either by biliary-enteric anastomosis or by sphincterotomy or sphincteroplasty. In the present report, 153 jaundiced patients operated on by sphincterotomy, were retrospectively examined. Proper indications for surgical sphincterotomy have been considered as follows: stones in the common bile duct (49.7%), biliary stones with secondary stenosis of Oddi (26.8%), impacted ampullary stones (17.6%), primary stenosis of Oddi (3.9%), stenosis of Oddi by perivaterian chronic pancreatitis (2.0%). Preoperative early diagnosis was recognized by US, ERCP, PTC, CT. The overall operative mortality was 2.6% and determined by acute renal failure in 2.0% and acute pancreatitis in 0.6%. Postoperative complications occurred in 4.6% and consisted in acute pancreatitis in 3.3% and bleeding from sphincterotomy in 1.3%. One hundred and twenty-three patients (82.5%) were followed up by questionnaire and by both X-ray studies and ultrasonography. Good results were observed in 80.5%, fair results in 17.1% and poor results in 2.4%. The presents study suggests further indications for surgical sphincterotomy in the treatment of benign biliary obstruction. The effectiveness of this procedure in the early management of non-malignant jaundice is also stressed.
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PMID:Surgical sphincterotomy in the early management of non-malignant obstructive jaundice. Indications and results. 667 93

Magnetic Resonance cholangiopancreatography (MRCP) is a new noninvasive imaging technique for the visualization of the biliary ducts with cholangiographic images similar to those obtained with ERCP and PTC, but with no contrast agent injection. In this paper, we report on our preliminary experience with a mild-field strength magnet (0.5T) and TSE sequences, acquired with respiratory compensation. The images were compared with ERCP images to compare diagnostic quality. Eighteen patients were examined: the biliary tract was dilated because of chronic pancreatitis in 3 patients, because of choledochal stones in 9, of carcinoma of the pancreatic head in 4, of lymphadenopathy in one patient. A patient submitted to choledochoduodenostomy and waiting for cholecystectomy was also examined. MRCP was performed with a superconductive magnet at 0.5T. Volumetric images on coronal planes were acquired; a T2-weighted TSE sequence (TR = 5000, TE = 244, Nex = 4, ETL = 45; acquisition time = 14 min 10 s) with respiratory compensation was also performed. The images were reconstructed on coronal planes at different angles with the MIP algorithm. All patients were then submitted to ERCP and one to PTC. In all patients, the intrahepatic biliary tracts, hepatic ducts and choledochus were completely demonstrated, with very good image quality in 16 cases and good in 2. The Wirsung duct was always visualized in all the 9 patients with mild to severe dilation. In conclusion, MRCP can be considered a valuable alternative to diagnostic ERCP. Further studies are necessary for better assessment of the potential advantages and pitfalls of this technique.
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PMID:[Magnetic resonance cholangiopancreatography. A new method of noninvasive biliopancreatic diagnosis]. 855 21

Magnetic resonance imaging of the biliary and pancreatic ducts, MRCP, is a technique developed over the last few years. Using strongly T2-weighted sequences, images of the biliary and pancreatic ducts similar to ERCP can be obtained within one single inhalation. No contrast media or medication is required. In 23 patients 25 MRCP examinations were retrospectively compared with ERCP or PTC. One patient had normal findings; three had gallbladder stones. Eight out of nine common bile-duct stones were shown. MRCP after papillotomy in one patient showed a common bile-duct stone; ERCP seven days later was normal. MRCP correctly showed obstruction and dilatation of the bileducts in ten patients with tumor and in one patient with chronic pancreatitis. Two of these were erroneously interpreted as caused by stone. 21 of 25 MRCPs were consistent with the final diagnosis. We consider MRCP a promising method which may replace diagnostic ERCP in majority of patients. Stones in the gallbladder and bile-ducts can be diagnosed. The method also shows obstructions and other lesions affecting pancreatobiliary ducts.
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PMID:[Magnetic resonance tomography of biliary and pancreatic ducts]. 1053 4

Endoscopic ultrasonography (EUS)-guided interventions are an essential tool for complex (such as combined or subsequent) therapeutic measures and are, in current as well as future endoscopy, an indispensable part of modern gastroenterology. Longitudinal EUS scanners allow one to puncture transluminally both mediastinal and abdominal lesions which cannot be approached with other techniques. Using the EUS-guided puncture of such pathological lesions, it becomes possible to perform further, more advanced endoscopic interventions which thus become safer as well as more efficient and are associated with a lower complication rate compared with conventional endoscopic or even surgical interventions. A crucial aspect in interventional EUS is the adequate, less traumatic treatment of pancreatic pseudocysts. The transluminal route for interventions spanning from the approach to the placement of a drainage for abscesses and/or necroses is considerably easier under EUS-guidance, including better outcomes. Novel approaches and interventions are the internal EUS-guided insertion of a transluminal (from the upper GI tract) I) cholangiodrainage in patients with malignant obstruction of the bile duct but no option to achieve sufficient conventional cholangiodrainage with ERC or PTC, II) pancreaticodrainage in symptomatic patients with enlarged pancreatic duct -/+ pancreatic fistula postoperatively or in patients with chronic pancreatitis, which may be considered new therapeutic strategies with non-operative intentions and/or low invasiveness.
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PMID:[Therapeutic endosonography]. 1853 83