kobayashi takashi

Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented.

A 62-year-old man was referred to our hospital after ultrasonographic mass screening detected a pancreatic cyst that proved to be an intraductal papillary mucinous neoplasm. Computed tomography additionally demonstrated air in the main pancreatic duct. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography delineated a filling defect in the main pancreatic duct in the body of the pancreas. The sphincter of Oddi was open. The main pancreatic duct was dilated by viscous mucin air in the duct was attributed to consequent dysfunction of the sphincter. Laboratory findings included no significant abnormality. The patient has remained asymptomatic during follow-up. Of 25 previously reported cases with air in the duct, only 1 involved an intraductal papillary mucinous neoplasm. © Springer 2013.

We investigated 2,152 patients with gallbladder polyps detected by ultrasonographic mass screening at our institution. Nine underwent cholecystectomy later, when polyps had enlarged. Seven others, most with larger polyps, underwent cholecystectomy shortly after polyp detection. Characteristics were compared between these 2 surgical groups. In patients with surgery upon enlargement, mean polyp diameter at the time of cholecystectomy was 12.9 mm and the mean polyp growth rate was 2.6 mm/year. Ultrasonographically, these polyps most often showed homogenous echo patterns resembling liver parenchyma. Pathological diagnoses were cholesterol polyps in 7; papillary hyperplasia in 1; and tubular adenoma in 1. In patients with surgery immediately upon detection, the mean polyp diameter was 13.1 mm. Ultrasonographically, these polyps often showed homogenous echo patterns that included small cystic structures. Pathological diagnoses included 5 cholesterol polyps, 1 inflammatory polyp, and 1 carcinoma in situ. The polyp diameter at detection in the immediate surgery group was significantly greater than that in the group with surgery upon enlargement. Single polyps were significantly more prevalent in immediate surgery patients than in the other group. Careful follow-up is required in patients monitored for polyp showing homogenous echo patterns resembling liver parenchyma, in which polyps are enlarged prior to surgery, considering that this group may include tubular adenoma or carcinoma in situ.