The Normal Endoscopic Pancreatogram in Koreans

Abstract

The establishment of endoscopic retrograde cholangiopancreatography (ERCP) as a valuable procedure in diagnostic evaluation of patients with suspected pancreatic disease requires the precise delineation of normal pancreatography. Therefore, to establish normal standards in Koreans of pancreatic ductal morphology, such as course, diameter and length including the shape of the ampulla and the success rate of the ERCP procedure, we analyzed the pancreatograms of persons with proven normal pancreatic status. Of the 449 cases showing normal duodenal papilla, the hemispherical type of shape (49.7%) was the most common, followed by the papillary type (36.5 %) and flat type (13.8%) in order of frequency. The success rate of ERCP procedure (1,020 cases) was 95.3%, and the selective success rate was 90.9% for the panceatic duct and 79.3% for the biliary tree. In the course of the pancreatic duct (286 cases), the ascending type of extension (51.7%) was the most common followed by the sigmoid type (25.2%), horizontal type (22.4%) and descending type (0.7%). The diameter of the pancreatic duct was 3.3 ± 0.8mm in the head, 2.4 ± 0.5mm in the body and 1.5 ± 0.5mm in the tail portion, and there was a tendency that the diameter of the pancreatic duct progressively increased with age. The length of the pancreatic duct was 17.5 ± 2.8cm. In conclusion we hope that, by utilizing these various parameters of the normal endoscopic retrograde pancreatogram, precise diagnosis will be possible.

Endoscopic Retrograde Cholangio‐pancreatography in Healthy Beagles

“…Similar to humans, both branches of the canine accessory pancreatic duct had a decrease in size from proximal to distal but with smaller mean duct diameters 44–46 . In humans, the mean diameter of the normal pancreatic duct is 3.1–3.3 mm in the head, 2.4 in the body and 1.4–1.5 mm in the tail, 45,46 and therefore, more than three times bigger than the mean duct diameter determined in the Beagles of this study. Like for endoscopic retrograde cholangiography, it is unknown whether the duct diameter correlates with the size of the dog breed and the age of the patient.…”

“…The length of the branches of the accessory pancreatic duct in Beagles was shorter than the pancreatic duct in humans 44,45 . However, it is to be expected that larger dog breeds also have longer pancreatic ducts.…”

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis

“…Identification of these abnormalities can be subjective as their definitions are not clear. Average normal main duct diameters were 3.6, 2.7 and 1.6 mm in the head, body and tail respectively(101), though the upper limited normal may be as high as 6.5, 5 and 3 mm in the head, body and tail, respectively(101–103). Main duct dilation is either general (involving more than 2/3 of the main duct) or local (< 2/3 of the ducts).…”

Variations in the Duct System of Pancreas: A Cadaveric Study

“…In the present study, the length of the major pancreatic duct ranged from 7 cm to 15 cm. In the study by Kang JK [10], the length of the pancreatic duct was 17.5 ± 2.8 cm. A study on normal pancreatic morphology done by Kochhar et al [11], the mean length of PD was 18.2 ± 3.0 cm, being longer in males but not varying with age.…”

“…Hadid A [14] got the same as 3mm in the head, 2.1 and 1.6 mm in the body proximal to and distal to the neck respectively. Kang et al [10] analyzed pancreatograms and got the diameter of the pancreatic duct as 3.3 0.8 mm in the head, 2.4 ± 0.5 mm in the body and 1.5 ± 0.5 mm in the tail portion. Mean ductal diameters in the head, body and tail of the pancreas were 2.63, 1.95, 0.99 mm in individuals aged less than or equal to 40 yr and 3.31, 2.34, 1.23 mm in those greater than 40 yr, respectively according to a study by Karak et al [15].…”