The recent development of endoscopic retrograde cholangiopancreatography (ERCP) now permits the collection of pure human pancreatic secretions via duodenoscopic cannulation. Study objectives are evaluation of exocrine pancreatic function and analysis of pure pancreatic juice collected by use of ERCP technique in subjects without pancreatic disease. From March to July 1993, we performed ERCP and collection of pure pancreatic juice in 10 patients without evidence of pancreatic disease. (continue...)
Catheterization* ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Humans ; Pancreatic Diseases ; Pancreatic Juice*

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor

No abstract available.
Amylases/analysis ; Bicarbonates/analysis* ; Chronic Disease ; Endoscopy, Digestive System ; Human ; Pancreas/physiology* ; Pancreatic Juice/secretion ; Pancreatic Juice/enzymology ; Pancreatic Juice/chemistry* ; Pancreatitis/metabolism ; Pancreatitis/diagnosis*

BACKGROUND: Pancreatic pseudocyst is the most common cystic lesion of pancreas, which is formed with leakage of pancreatic juice by pancreatic duct injury, surrounded by around intraperitoneal organs and tissue. METHODS: The study subjects consist of 18 patients who undergone primarily percutaneous catheter drainage(PCD) from January of 1995 to December of 1998 at Pusan National University Hospital. RESULTS: The peak incidence was in the age group of 20 to 40 years and male gender was somewhat dominant. The cause of pancreatic pseudocyst was mainly trauma(61.1%), the most common location of injury site was body of pancreas. The initial diameter of pancreatic pseudocyst was above 6 cm(72.2%) and the size was reduced in 13 cases(72.2%) of 18 cases during treatment. Mostly the amount of drainage through PCD was below 100mL(55.6%) and the amount was decreased in 13 cases during treatment. Spontaneous resolution of pancreatic pseudocyst was occurred in 11 cases, among them 3 cases were recurred. Persistent or recurred cases were undergone secondary procedure, internal drainage in 6 cases, retrial of PCD in 2 cases, distal pancreatectomy in 1 case, zther in 1 case. CONCLUSION: The percutaneous catheter drainage performed within initial 6 weeks for spontaneous resolution of pancreatic pseudocyst or maturation of cystic wall is considered as alternative treatment of pancreatic pseudocyst.
Busan ; Catheters ; Drainage* ; Humans ; Incidence ; Male ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatic Pseudocyst*

BACKGROUND: The aims of this study were to evaluate the diagnostic value of pancreatic elastase-1(PE-1) in patients with pancreatic diseases and compare the significance of PE-1 with that of pancreatic exocrine function test by pure pancreatic juice (PPJ) collection. METHODS: For evaluation of PE-1, seventy nine patients with pancreatic diseases were examined. For evaluation of exocrine pancreatic function by PPJ, twenty three patients with Chronic pancreatitis(CP) were examined. PPJ was collected by endoscopic cannulation of main pancreatic duct under the intravenous bolus injection of secretin (0.25 CU/kg body weight) and cholecystokinin (CCK, 40 ng/kg body weight). RESULTS: Pancreatic exocrine functions were significantly decreased in patients with CP showing moderate and severe ductal changes on pancreatogram. The mean concentration of fecal PE-1 was significantly decreased in patients with CP and pancreatic cancer, but not in patients with acute pancreatitis. When we analyzed the PE-1 concentration according to Cambridge classification, the concentration of fecal PE-1 was significantly decreased only in patients with moderate and severe CP. With a cut off of 200 ug fecal PE-1/g, the sensitivity of PE-1 was 25%, 60%, and 100%, respectively, for mild, moderate and severe CP, and the specificity was 88.1%. The mean concentration of serum PE-1 was increased both in patients with acute and chronic pancreatitis, but there was no difference between both group. CONCLUSION: Fecal PE-1 is useful for diagnosis of pancreatic exocrine insufficiency in patients with CP, especially in moderate and severe grade of pancreatic exocrine insufficiency. The diagnostic value of fecal PE-1 was also similar to secretin-CCK test in pancreatic exocrine insufficiency.
Catheterization ; Cholecystokinin ; Classification ; Diagnosis ; Humans ; Pancreatic Diseases* ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Secretin ; Sensitivity and Specificity

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

Pancreaticogastrostomy (PG) has been used as an alternative procedure for pancreaticojejunostomy (PJ) for reconstruction after a pancreaticoduodenectomy (PD). Leakage at the pancreatoenteric anastomosis is still a major cause of morbidity and mortality after a PD. Therefore the major goal of technical modifications should be elimination or at least a reduction of pancreatic leakage. A number of published studies have shown that PG is associated with a low rate of anastomotic leakage. PG is easier to perform due to the thick posterior wall of the stomach and its excellent blood supply being proximal to the remaining pancreas. Furthermore, the pancreatic juice appears to be neutralized by the gastric juice, resulting in a reduction in the morbidity and mortality associated with anastomotic leakage. PG also results in a straight alignment of the digestive tract without an A-loop. PG and PJ showed an impaired exocrine and endocrine pancreatic function with a similar extent. The activity of the pancreatic enzymes is inhibited in the stomach after a PG. The enzymes become activated when gastric pH exceeds 3.1, which normally occurs after the ingestion of a meal. In conclusion, we recommend duct-to-mucosa PG as a beneficial alternative to a PJ, even in the hands of an inexperienced surgeon.
Anastomotic Leak ; Eating ; Gastric Juice ; Gastrointestinal Tract ; Hand ; Hydrogen-Ion Concentration ; Meals ; Mortality ; Pancreas ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Stomach

PURPOSE: A pancreatic fistula is the most dreaded complication following a pancreaticoduodenenctomy, and various methods have been used to for its prevention. This study was designed to evaluate the role of external tube drainage of the pancreatic duct, and the use of octreotide in preventing complications following a pancreaticoduodenectomy. METHODS: 137 patients (82 men, 55 women; mean age 63.3 years) diagnosed with either a periampullary cancer (115), chronic pancreatitis (13), or trauma (9) and who had undergone a pancreaticoduodenectomy (classic Whipples' operation (78), PPPD (59)) were evaluated. The patients were divided into 3 groups; Group A (n=31): with externally drained pancreatic juice, but with out the use of octreotide, Group B (n=56): with externally drained pancreatic juice, and the used of octreotide, and Group C (n=50): with the used of octreotide only with no external tube drainage. RESULTS: The morbidity and mortality were 38/137 (28%) and 2/137 (1.5%), respectively. A pancreatic fistula developed in 7 cases (5%), but no statistically significant differences were shown between the groups. The levels of serum amylase on the 1st, 3rd, 5th and 7th postoperative days were lower in groups B and C, those using octreotide (P<0.01). The level of amylase in the drain fluid were also lower in groups B and C on the 7th day (P<0.01). Group C had the lowest amylase levels in both the serum and drain fluid. CONCLUSION: The external drainage of pancreatic juice is considered to be of little significance in preventing complications following a pancreaticoduodenectomy, but the postoperative use of octreotide is helpful in preventing complications due to the prevention of postoperative pancreatic sweating.
Amylases ; Drainage* ; Female ; Humans ; Male ; Mortality ; Octreotide* ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticoduodenectomy* ; Pancreatitis, Chronic ; Sweat ; Sweating

BACKGROUND/AIMS: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation of the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. METHODS: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. RESULTS: When we regarded mean-1.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. CONCLUSIONS: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.
Amylases ; Catheterization ; Hand ; Humans ; Injections, Intravenous ; Intubation ; Lipase ; Pancreatic Ducts ; Pancreatic Function Tests ; Pancreatic Juice ; Pancreatitis, Chronic* ; Secretin* ; Sensitivity and Specificity