Assessment ofendoscopic retrograde cholangio- pancreatography (ERCP)andpurepancreatic juicecytology inpatients withpancreatic disease

SUMMARY Purepancreatic juice hasbeencollected from61patients atthetimeofendoscopic retrograde cholangio-pancreatography (ERCP)forthepurposeofcytodiagnosis. TheERCPand cytological findings arediscussed. Purepancreatic juice cytology may helpintheinterpretation of thepancreatogram inbothpancreatitis andpancreatic carcinoma. Inpatients withpancreatic carcinoma, ERCPalone was diagnostic in65%,cytology alone in54%. Bycombining these two approaches, adiagnostic result was obtained in92% ofpatients. Theintroduction ofERCPtoGreatBritain inthe last four yearshasbeena majoradvance inthe investigation ofpancreatic andbiliary disease (Cotton, 1972). Thisinvestigation isbothpractical andsafe, butthere can beconsiderable difficulties intheinterpretation ofthepancreatogram. Although theexfoliative cytology ofduodenal aspirates forthediagnosis ofpancreatic disease has beenpractised since 1949(Lemon andByrnes, 1949), ithasnotbecome aroutine investigation. Duodenal intubation anddrainage aretimeconsuming and there aremajordifficulties intheinterpretation of thecytological findings. Using thetechnique ofendoscopic cannulation of thepapilla ofVater, ithasbeenpossible tocollect purejuice directly fromthepancreatic ductforthe purposeofcytodiagnosis. Inthis study, purepancreatic juice was collected atthetimeofERCPandthevalue ofthis combined diagnostic approach isassessed inpatients withand without pancreatic disease.