Abstract
Magnetic resonance pancreatography is a new modality to visualize the pancreatic duct. Prolonged dilation of the pancreatic duct following secretin administration may suggest obstruction at the level of the pancreatic duct orifice. We describe 10 patients with idiopathic acute recurrent pancreatitis who underwent secretin-stimulated magnetic resonance pancreatography with subsequent endoscopic retrograde pancreatogram with or without manometry. All patients had complete visualization of the main pancreatic duct and no evidence of chronic duct disease. Two patients had pancreas divisum. Three had prolonged dilation of the pancreatic duct on secretin-stimulated magnetic resonance pancreatography and evidence of pancreatic duct outflow obstruction. Four additional patients with pancreatic duct outflow obstruction had normal secretin-stimulated magnetic resonance pancreatography. In conclusion, secretin stimulated magnetic resonance pancreatography provides high quality pancreatic duct images and has high specificity but low sensitivity for diagnosing pancreatic duct outflow obstruction using manometric/clinical criteria.
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REFERENCES
Tarnasky PR, Hawes RH: Endoscopic diagnosis and therapy of un-explained (idiopathic) acute pancreatitis. Gastrointest Endosc Clin North Am 2:13–37, 1998
Toouli J, Roberts-Thomson IC, Dent J, Lee J: Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 72:859, 1985
Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K:Idiopathic recurrent pancreatitis: Anapproach to diagnosis and treatment.Dig Dis Sci 34:56–60, 1989
Catalano MF, Sivak MV, Falk GW: Idiopathic pancreatitis: Diagnostic role of sphincter of Oddi manometry and response to endoscopic sphincterotomy. Gastrointest Endosc 39:310, 1993
Geenen JE, Nash JA: The role of sphincter of Oddi manometry and biliary microscopy in evaluating idiopathic recurrent pancreatitis. Endoscopy 30(suppl 2):A237–A241, 1998
Lehman GA, Sherman S: Sphincter of Oddi dysfunction. Int J Pancreatal20:11–25, 1996
Guelrud M, Mendoza S, Viera L: Idiopathic recurrent pancreatitis and hypercontractile sphincter of Oddi: Treatment with endoscopic sphincterotomy and pancreatic duct dilation. Gastroenterology 90:1443, 1986 (abstract)
Stone JE, Hogan WJ, Geenen JE, Wilson SD, Dodds WJ: Acute recurrent pancreatitis: The role of sphincter of Oddi manometry in predicting long-term benefit of therapy. Gastroenterology 94:A446,1988
Raddawi HM, Geenen JE, Hogan WJ, Dodds WJ, Venu RP: Pressure measurements from biliary and pancreatic segments of sphincter of Oddi: comparison between patients with functional abdominal pain, biliary or pancreatic disease. Dig Dis Sci 36:71, 1991
Sherman S, Jamidar P, Reber H: Idiopathic acute pancreatitis: Endoscopic approach to diagnosis and therapy. Am J Gastroenterol 88:1541, 1993 (abstract)
Kaw M, Verma R, Brodmerkel GJ: ERCP, biliary analysis, sphincter of Oddi manometry in idiopathic pancreatitis and response to endoscopic sphincterotomy. Am J Gastroenterol 91:1935, 1996 (abstract)
Wehrman T, Zipf A, Caspary WF, Jung M: Sphincter of Oddi dysfunction in idiopathic recurrent pancreatitis of unknown cause. Dtsch Med Wochenschr 121:781, 1996
Coyle W, Tarnasky P, Knapple W, Pineau B, Brooker C, Hoffman B: Evaluation of unexplained acute pancreatitis using ERCP, sphincter of Oddi manometry, and endoscopic ultrasound. Gastrointest Endosc 43:378, 1996 (abstract)
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM: Complications of endoscopic biliary sphincterotomy.N Engl J Med 335:909, 1996
Sherman S, Ruffolo T, Hawes R, Lehman GA: Complications of endoscopic sphincterotomy: A prospective series with emphasis on the increased risk associated with sphincter of Oddi dys-function and non-dilated bile ducts. Gastroenterology 101:1068, 1991
Gottlieb K, Sherman S: ERCP and biliary endoscopic sphincterotomy induced pancreatitis. Gastrointest Endosc Clin North Am 6:87–114, 1998
Sherman S, Lehman GA: ERCP and endoscopic sphincterotomy induced pancreatitis. Pancreas 6:350–367, 1991
Sherman S, Lehman G: Endoscopic pancreatic sphincterotomy: Techniques and complications. Gastrointest Endosc Clin North Am 7:115–124, 1998
Tarnasky P, Cunningham J, Cotton P, Hoffman B, Palesch Y, Freeman J, Curry N, Hawes R: Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis. Endoscopy 29:285–287, 1997
Bolondi L, Gaiani S, Gullo L, Lobo G: Secretin administration induces a dilation of main pancreatic duct. Dig Dis Sci 29:802–808, 1984
Tulassay Z, Jakab Z, Vadasz A, Kelemen E, Gupta R: Secretin provocation ultrasonography in the diagnosis of papillary obstruction in pancreas divisum. Gastroenterol J 51:47–50, 1991
Warshaw AL, Simeone JF, Schapiro RH, Flavin-Warshaw B: Evaluation and treatment of the dominant dorsal duct syndrome (pancreas divisum redefined). Am J Surg 159:59–66, 1990
Francesco VD, Brunori MP, Rigo L, Toouli J, Angelini G, Frulloni L, Bovo P, Filippini M, Vaona B, Talamini G, Cavallini G: Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent pancreatitis. Dig Dis Sci 44:336–340, 1999
Takehara Y, Ichijo K, Tooyama N, Kodaira N, Yamamoto H, Tatami M, Saito M, Watahiki H, Takahashi M: Breath Hold MR Cholan-giopancreatography with a long-echo-train, fast spin-echo sequence and a surface coil in chronic pancreatitis. Radiology 192:73–78, 1994
Soto JA, Barish MA, Yucel KE, Ferrucci JT: Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 196:459–464, 1995
Barish MA, Yucel KE, Soto JA, Chuttani R, Ferrucci JT: MRcholan-giopancreatography: Efficacy of three dimensional turbo spin-echo technique. Am J Radiol 165:295–300, 1995
Matos C, Metens T, Deviere J, Nicaise N, Brande P, Van Yperen G: Pancreatic duct: morphological and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 203:435–441, 1997
Sherman S, Gottlieb K, Uzer MF, Smith MT, Khusro QE, Earle DT, Brunelle RL, Hawes RH, Lehman GA: Effects of meperidine on the pancreatic and biliary sphincter. Gastrointest Endosc 44:239–242, 1996
Sherman S, Hawes RH, Troiano FP, Lehman GA: Pancreatitis following bile duct sphincter of Oddi manometry: Utility of the aspirating catheter. Gastrointest Endosc 38:397–350, 1992
Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP: The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter of Oddi dysfunction. N Engl J Med 320:82–87, 1989
Warshaw AL, Simeone J, Schapiro RH, Hedberg SE, Mueller PE, Ferrucci JT: Objective evaluation of ampullary stenosis with ultra-sonography and pancreatic stimulation. AmJ Surg 149:65–72, 1985
Carr-Locke DL, Gregg JA, Chey WY: Effects of exogenous secretin on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma secretin level. Dig Dis Sci 30:909–917, 1985
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Khalid, A., Peterson, M. & Slivka, A. Secretin-Stimulated Magnetic Resonance Pancreaticogram to Assess Pancreatic Duct Outflow Obstruction in Evaluation of Idiopathic Acute Recurrent Pancreatitis: A Pilot Study. Dig Dis Sci 48, 1475–1481 (2003). https://doi.org/10.1023/A:1024747319606
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DOI: https://doi.org/10.1023/A:1024747319606