Patency of the Accessory Pancreatic

Terumi Kamisawa
Tokyo Metropolitan Komagome Hospital. Tokyo, Japan
Dear Sir:
I read the paper by Hernández Garces et al.
[1] with interest and I have some questions.
I have prospectively examined patency of the
accessory pancreatic duct (APD) by dye-
pancreatography in 410 cases (291 controls,
46 acute pancreatitis, 32 chronic pancreatitis,
27 pancreaticobiliary maljunction, and 14
intraductal papillary mucinous tumor of the
pancreas) [2, 3, 4]. Egress of dye from the
endoscopically was taken as an indication of
APD patency. Patency of the APD in the
control group was 43% (125/291). APD
patency was correlated to the course and
shape of the APD: patency in the long type
(75%) was significantly greater than in the
intermediate (38%), short (34%), or ansa
types (15%) (P<0.01). The shape of the
terminal portion was also correlated with
patency of the APD: patency in the spindle
type (93%) and cudgel type (88%) was
significantly greater than in the branch type
(7%) and saccular type (14%) (P<0.01).
Patency of the APD in patients with acute
pancreatitis was 17% (8/46), significantly less
than in the control group (P<0.01). I think that
a patent APD may prevent acute pancreatitis
by reducing pressure in the main pancreatic
Patency of the APD in 32 patients with
chronic pancreatitis was 32%. The APD was
not detected in 6 cases and obliteration of the
APD near the duodenum was seen in 4 cases.
Cudgel appearance of the APD was detected
in 8 cases, wherein the main pancreatic duct
was also dilated. I think the appearance of the
APD in patients with chronic pancreatitis is
sometimes changed by acquired factors due to
stagnation of pancreatic juice.
I wonder what the patency of APD is in
patients with chronic pancreatitis in
Hernández Garces series, and how many
cases show no APD or halfway APD.
Received January 26th, 2004
Endoscopic Retrograde; Pancreatic Ducts;
Pancreatitis; Pancreatitis, Alcoholic
Abbreviations APD: accessory pancreatic
Terumi Kamisawa
Department of Internal Medicine
Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku
Tokyo 113-8677
1. Hernández-Garcés HR, Lazo del Vallin S,
Moutary I. The value of a pancreatogram in chronic
pancreatitis diagnosed by endoscopic retrograde
cholangiopancreatography. JOP. J Pancreas (Online)
2004; 5:25-31. [PMID 14730119

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