Endoscopic papillary balloon dilatation (EPBD) was reported as a less invasive treatment for bile duct stone. It has advantages of reduced risk of bleeding and preserved papillary function, compared with endoscopic sphincterotomy (EST). However, recurrence of stone has not been elucidated as yet. The problem of EPBD is the high incidence of post‐procedure pancreatitis. Reported as risk factors of the pancreatitis are pancreatography, past history of pancreatitis, difficult bile duct cannulation, excessive pressure to the papilla etc. Appropriate measures to prevent post‐EPBD pancreatitis are therefore indispensable.
Gallbladder cancer occurs frequently in patients with pancreaticobiliary maljunction due to pancreatobiliary reflux. Pancreatobiliary reflux is also detected in some patients with a relatively long common channel. This study aimed to clarify the correlation between pancreatobiliary reflux and the length of a common channel.Two hundred and three patients, in whom both the length of a common channel and amylase level in the bile were measured, were enrolled from nine centers.Bile amylase level was correlated with the length of a common channel (P < 0.01). The minimum length of a common channel that could induce a markedly elevated amylase level in the bile (>1,000 mg/dl) was determined as 5 mm. We redefined high confluence of pancreatobiliary ducts (HCPBD) as cases with a common channel > or = 5 mm, in which the communication between the pancreatic and bile ducts was occluded with the sphincter contraction. Gallbladder cancer was found in 20% of 56 redefined HCPBD patients. Bile amylase level >1,000 mg/dl and biliopancreatic reflux were detected in 79 and 95% of the patients, respectively.Patients with a common channel > or = 5 mm (redefined HCPBD) should be monitored for the development of gallbladder cancer, as they frequently showed significant pancreatobiliary reflux.
Pancreatic ductal adenocarcinoma (PDAC) may derive from an intraductal papillary mucinous neoplasm (IPMN) of the pancreas or may develop in the pancreatic duct apart from IPMN. The purpose of this study was to define the clinicopathological features of these 2 entities and compare them with those of ordinary PDAC.Of 765 patients who had surgical resection for IPMN, 122 were diagnosed as having PDAC derived from IPMN and 31 with PDAC concomitant with IPMN. In addition, 7605 patients with PDAC who were registered in the Japan Pancreas Society pancreatic cancer registry were compared with the above patients.Pancreatic ductal adenocarcinomas derived from IPMN and concomitant with IPMN were significantly smaller, less invasive, and less extensive than ordinary PDAC. The median survival of patients with the 2 conditions was significantly longer than for those with ordinary PDAC when compared overall or when limited to TS2 (2.0 cm < tumor size ≤ 4.0 cm) or TS3 (4.0 cm < tumor size ≤ 6.0 cm) cases.These findings suggest that PDAC concomitant with IPMN and PDAC derived from IPMN may have more favorable biological behaviors or be diagnosed earlier than ordinary PDAC.
We carried out the first questionnaire survey about pancreas and biliary endoscopy Japan. The questionnaire was distributed to 19 institutions during the period 4 months and we gathered information from 1193 respondents. The endoscopic approaches to bile duct‐related regions accounted for 81% of all procedures. Therapy accounted for 74% of these. The examination and therapy procedures both achieved a success rate of over 80% The standard type of cannula was the first choice in 52% of endoscopic retrograde pancreatography (ERP) and 45% of endoscopic retrograde cholangiography (ERC). The short taper type (30%) is the second choice in ERP, and the short taper type (26%) and long taper (22%) are the second choice in ERC. EST is currently used in 71% of bile duct stone endoscopies in Japan, where EPBD was thought to be relatively prevalent. Various types (over 30) of sphincterotomes are used and the overall frequencies of guidewire usage are 65%.
