The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure-related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.
Sex Factors ; Pancreatitis/diagnosis/pathology ; Pancreatic Ducts/*anatomy & histology/*pathology ; Pancreatic Diseases/diagnosis ; Middle Aged ; Male ; Humans ; Female ; Common Bile Duct/anatomy & histology/pathology ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Bile Ducts/*anatomy & histology/metabolism/pathology

The aim of this study was to detect the relationship between age and biomechanical properties in porcine common bile duct (CBD). The CBDs of 50 Hubei white pigs aged 3-12 months were obtained. The experiment of pressure-diameter was conducted on the biomechanical experiment stand for soft tissues, and then the elastic modulus and compliance were calculated. The materials were transversely extracted, refrigerated, and sliced up before HE staining. The diameter and wall thickness of the CBD were measured by a computer image analysis system. The results showed that there was statistically significant difference in regard to the compliance of the porcine CBDs of different months (F = 59.69, P = 0.00). The compliance of the porcine CBD increased gradually with monthly age. However, after the pigs being aged 10 months, the compliance decreased gradually with monthly age. The compliance of the CBD of pigs aged 7-10 months was not significantly different (P > 0.05), but the compliance of the CBDs of pigs' aged 3-6 months and 11-12 months was significantly lower than that of pigs aged 7-10 months (P < 0.01). The changes in elastic modulus of porcine CBD with age were opposed to the changes in compliance. The results of the present study suggests that the in biomechanical properties of pigs' CBDs change with their ages, and the CBDs of pigs aged 7-10 months have good compliance. Thus, for the pig-to-human liver xenotransplantation, the livers of pigs aged 7-10 months, being chosen as donators, may be more conducive to matching.
Age Factors ; Aging ; physiology ; Animals ; Biomechanical Phenomena ; Biophysical Phenomena ; Common Bile Duct ; anatomy & histology ; physiology ; Compliance ; physiology ; Elastic Modulus ; physiology ; Swine ; Transplantation, Heterologous

OBJECTIVE: To compare the efficacy of Mangafodipir trisodium (Mn-DPDP) -enhanced MR cholangiogrphy (MRC) and Gadobenate dimeglumine (Gd-BOPTA) -enhanced MRC in visualizing a non-dilated biliary system. MATERIALS AND METHODS: Eighty-eight healthy liver donor candidates underwent contrast-enhanced T1-weighted MRC. Mn-DPDP and Gd-BOPTA was used in 36 and 52 patients, respectively. Two radiologists reviewed the MR images and rated the visualization of the common duct, the right and left hepatic ducts, and the second-order branches using a 4-point scale. The contrast-to-noise ratio (CNR) of the common duct to the liver in the two groups was also compared. RESULTS: Mn-DPDP MRC and Gd-BOPTA MRC both showed similar visualization grades in the common duct (p = .380, Mann-Whitney U test). In the case of the proximal bile ducts, the median visualization grade was significantly higher with Gd-BOPTA MRC than with Mn-DPDP MRC (right hepatic duct: p = 0.016, left hepatic duct: p = 0.014, right secondary order branches: p = 0.006, left secondary order branches, p = 0.003). The common duct-to-liver CNR of the Gd-BOPTA MRC group was significantly higher (38.90+/-24.50) than that of the Mn-DPDP MRC group (24.14+/-17.98) (p = .003, Student's t test). CONCLUSION: Gd-BOPTA, as a biliary contrast agent, is a potential substitute for Mn-DPDP.
Pyridoxal Phosphate/*analogs & derivatives/diagnostic use ; Organometallic Compounds/*diagnostic use ; Middle Aged ; Meglumine/*analogs & derivatives/diagnostic use ; Male ; *Magnetic Resonance Imaging ; Humans ; Hepatic Duct, Common/anatomy & histology ; Female ; Feasibility Studies ; Edetic Acid/*analogs & derivatives/diagnostic use ; *Contrast Media ; Common Bile Duct/anatomy & histology ; Bile Ducts/*anatomy & histology ; Aged ; Adult

BACKGROUND/AIMS: Various anatomical features of the biliary tree affect ability to remove difficult common bile duct (CBD) stones. In this study, we evaluated the clinical characteristics and outcomes of the endoscopic treatment of stones in stemware-shaped CBDs. METHODS: Thirty-four patients with a stone and a stemware-shaped CBD who were treated at different tertiary referral centers from January 2008 to December 2012 were studied retrospectively. When stone removal failed, percutaneous or direct peroral cholangioscopic lithotripsy, endoscopic retrograde biliary drainage, or surgery was performed as a second-line procedure. RESULTS: The overall success rate of the first-line procedure was 41.2%. Five of the 34 patients (14.7%) experienced procedure-related complications. No procedure-related mortality occurred. Mechanical lithotripsy was required to completely remove stones in 13 patients (38.2%). Conversion to a second-line procedure was required in 20 patients (58.8%). Mechanical lithotripsy was needed in 75% and 66.7% of those with a stone size of <1 cm or > or =1 cm, respectively. Stone recurrence occurred in two patients (9.1%) after 6 months and 27 months, respectively. CONCLUSIONS: The endoscopic treatment of stones in a stemware-shaped CBD is challenging. The careful assessment of difficult CBD stones is required before endoscopic procedures.
Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects/methods ; Choledocholithiasis/complications/*surgery ; Common Bile Duct/*anatomy & histology/surgery ; Endoscopy, Gastrointestinal/adverse effects/*methods ; Female ; Humans ; Lithotripsy/adverse effects/*methods ; Male ; Middle Aged ; Treatment Outcome

BACKGROUND/AIMS: Periampullary diverticulum (PAD) causes difficulty in the extraction of common bile duct (CBD) stones with conventional endoscopic therapy. Our study was designed to evaluate the effect of PAD on endoscopic large balloon dilation (EPLBD) with/without limited endoscopic sphincterotomy (EST) for CBD stone treatment. METHODS: We retrospectively reviewed cases of 141 patients treated CBD stones by EPLBD with/without limited EST at Gachon Gil Medical Center from September 2008 to February 2010. PAD were classified into three groups according to the location of the papilla and diverticulum. Clinical parameters, endoscopic parameters, and procedure outcomes were analyzed. RESULTS: PAD were identified in 46.1% (65/141), with 23 male (35.4%) and 42 female (64.6%) and a mean age of 72.9+/-11.1 years. Mean diameter of the stones was 14.8+/-6.0 mm and mean diameter of CBD was 21.6+/-7.7 mm. PAD group was significantly older than control group (72.9 vs. 68.6, p=0.043) and the incidence of large stone (> or =15 mm) was higher in PAD group (60.0% vs. 42.1%, p=0.034). Success rate of complete removal of stones in the first session was 32/65 patients (49.2%) and overall successful complete stone removal rates was 63/65 (96.9%). There was no significant difference between the PAD and control groups in success rate. Major complications were similar between two groups. CONCLUSIONS: PAD is associated with an increased incidence of large bile duct stones and older age. PAD seems to not increase technical failure rate or complication risk on EPLBD with/without limited EST.
Age Factors ; Aged ; Aged, 80 and over ; *Balloon Dilation ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct/anatomy & histology ; Diverticulum/*diagnosis ; Duodenal Diseases/*diagnosis ; Female ; Gallstones/surgery/*therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome