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The roentgenologic visualization of excretory ducts of a secreting organ is a longe-stablished diagnostic method in roentgenology. For a long time, radiologists have felt the need to establish a method for filling the excretory duct system of the pancreas with contrast material, in the way that intravenous retrograde urography is used to diagnose pathologic changes such as displacement of the renal collecting system or of the urethra. This need to establish a method became more urgent the more the pancreas resisted conventional roentgenologic clinical di agnostic methods. From time to time in peroperative or postoperative cholangiography mostly incomplete reflux into the pancreatic duct in 10-14% was observed (Stiller, 1948; San Julian und Pascual y Megias, 1952; Wapshaw, 1955; Bergkvist und Seldinger, 1957). However, there was no possibility of obtaining reliable and complete opacification of the pancreatic duct. Peroperative Pancreaticography It was in 1951 when Leger and Arway achieved this goal, though only by surgery. It should be mentioned that, when performing their first peroperative examination, these French surgeons already had the impression, that cannulation of the pancreatic duct was easier than cannulation of the common bile duct. This observation has been con firmed by hundreds of examinations after ERPC had been established for several years; however, up till now this phenomenon has not been sufficiently explained. During the following years, peroperative pancreaticography develop ed into a routine examination, above all by Doubilet et al.
List of contents
1. Introduction.- Peroperative Pancreaticography.- Terminology.- 2. The History of Pancreaticography.- 2.1 Experiments on Pancreaticography by Means of a Balloon Catheter.- 2.2 Experiments on Pancreaticography by Direct Puncture of the Pancreatic Parenchyma.- 2.3 Experiments on Transvenous Pancreaticography.- 2.4 Development of the Endoscopic Retrograde Pancreaticocholangiography.- 3. Techniques.- 3.1 Equipment.- 3.2 Preparation of the Patient.- 3.3 Technique of ERPC.- 3.4 Technical Difficulties in ERPC.- 4. Indications, Contraindications, and Complications.- 4.1 Indications for ERPC.- 4.2 Contraindications.- 4.3 Hazards, Complications, and Treatment.- 5. The Normal Retrograde Pancreaticogram (including anomalies and deformities).- 5.1 Site of the Papilla of Vater.- 5.2 The Anatomy of the Papilla of Vater.- 5.3 Main Duct and Side Branches of the Pancreas.- 5.4 Width of the Pancreatic Main Duct.- 5.5 Different Types and Variations of the Orifice.- 5.6 The Normal Emptying Process of the Pancreatic Duct.- 5.7 Transpapillary Pressure Measurement in the Pancreatic Duct and the Common Bile Duct.- 6. The ERPC Roentgenographic Pattern in Changes Due to Age.- 7. The ERPC in Lesions of the Pancreas and the Papilla Duodeni.- 7.1 Annular Pancreas.- 7.2 Chronic Pancreatitis, Chronic Relapsing Pancreatitis, Calculous Pancreatitis.- 7.3 Necrotizing Lesions and Pseudocysts.- 7.4 Papillary Stenosis and Papillary Spasm.- 7.5 Benign Tumors of the Pancreas.- 7.6 Carcinoma of the Pancreas.- 7.7 Papillary Carcinoma.- 7.8 Metastases of Tumors to the Pancreas.- 7.9 Posttraumatic Conditions of the Pancreas.- 7.10 Postoperative Conditions of the Pancreas.- 8. ERPC in Diseases of the Biliary Tract.- 8.1 Primary Sclerosing Cholangitis.- 8.2 Secondary Sclerosing Cholangitis and Postoperative Conditions of the Biliary Tract.- 8.3 Calculous Disease of the Bile Ducts and the Gallbladder.- 8.4 Carcinoma of the Bile Ducts and Carcinoma of the Liver.- 8.5 Stenosis of the Common Bile Duct Secondary to Diseases of Pancreas and Liver.- 9. Correlation of ERPC with Other Roentgenologic Examinations of the Pancreas.- 10. Conclusion.- 11. References.- 12. Subject Index.
