Endoscopic Retrograde Pancreatic Duct Cannulation (ERPC): An Aid to Pancreatic Surgery

Retrograde endoscopic pancreatic duct cannulation for evaluation of patients with chronic pancreatitis is reviewed over the last two years. Of 40 patients that were endoscoped, 30 had a successful pancreatogram. The X-ray findings fell into three groups: 1) single and multiple stenosis, 2) diffuse narrowing, and 3) apparently normal duct. This procedure proved of value in ruling out or delaying surgical operation in 10 persons. Twenty-one patients underwent operations. Thirteen had a 95% pancreatectomy, one had drainage of a necrotic collection thought to be a pseudocyst and one had a pseudocyst resected. One had a gastrojejunostomy and vagotomy bypassing a stenosis of the second portion of the duodenum and three had exploratory laparotomies. In five of the operated patients, the papilla could not be entered because of retraction, scarring or edema. In eight the correlation of the ductogram and the pathology found in resected specimen was good, while in another seven patients the resected specimen showed much more pathology than was suspected from the ductogram. While the pancreatogram fortifies clinical judgment. It is not always reliable as an indicator of the need for surgical versus medical treatment