CLINICAL SIGNIFICANCE OF PANCREATIC ANGIOGRAPHY IN THE DIAGNOSIS OF CHRONIC PANCREATITIS

Abstract

To evaluate the angiographic findings in the diagnosis of chronic pancreatitis, selective celiac and superior mesenteric arteriographies (SCA-SSMA) were performed in 29 patients with chronic pancreatitis. In 16 cases out of 29 subjects, the catheter was more carefully introduced to dorsal pancreatic artery and superselective dorsal pancreatic arteriography (SDPA) was done. These angiographic findings were compared with other diagnostic procedures such as endoscopic retrograde cholangiopancreatography (ERCP), oral glucose tolerance test (OGTT) and Pancreozymin-Secretin (P-S) test. With the use of SDPA, caliber irregularity or stenosis of pancreatic artery, hypervascularity in arterial phase and stain in capillary phase were more frequently observed than with SCA-SSMA, especially the stain was observed in 81% of the cases (p<0.05) when compared to 45% with the use of SCA-SSMA. In the cases of more than ten years' duration, hypervascularity and parenchymal stain were no longer observed in SCA-SSMA, and irregularity of surrounding arteries was characteristically encountered. In the cases with marked ductal changes in ERCP, the incidence of caliber irregularity of pancreatic artery and irregularity of surrounding arteries were 50% and 83% respectively, on the other hand, mild-ductal-changed group showed no such findings at all. Concerning the OGTT, the diabetic curves were observed more frequently in the cases which showed hypervascularity and less degree of parenchymal stain. When P-S test was compared with angiography, caliber irregularity of pancreatic artery and parenchymal stain were more frequently seen. In relation to the history of alcohol intake, caliber irregularities of pancreatic and surrounding arteries, andparenchymal stain were more frequently seen in the cases with heavy alcohol intake. Pancreatic arteriography, especially SDPA, is therefore a very useful and superb procedure in the diagnosis of chronic pancreatitis.