Clinical study on simultaneous bacterial and fungal culture of bile and pancreatic juice in acute biliary pancreatitis / 中华肝胆外科杂志

Objective:To investigate the characteristics and clinical significance of distribution of bacteria and fungi in pancreatic fluid and bile in patients with acute biliary pancreatitis (ABP).Methods:The clinical data of patients with ABP who underwent endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct stenting with simultaneous bacterial and fungal culture of bile and pancreatic fluid at the Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University from January 1, 2019, to June 30, 2021 were retrospectively analyzed. Of 202 patients, there were 102 males, and 100 females, aged (54±16) years old. Patients were divided into two groups by presence or absence of pancreatic infection: the pancreatic infection group ( n=20) and the non-pancreatic infection group ( n=182). Of the 76 patients with positive bile bacterial cultures, 60 patients with positive pancreatic fluid bacterial cultures were included in the positive pancreatic fluid culture group and 16 patients with negative pancreatic fluid cultures were included in the negative pancreatic fluid culture group. The clinical data including the type and distribution of bacteria cultured, complications, and co-infections of patients were compared. Factors associated with pancreatic infection were analyzed using logistic regression and the value of assessment of the associated factors was analyzed by plotting the receiver operating characteristic (ROC) curve. Results:Of 404 specimens (202 each of pancreatic fluid and bile) were sent for examination, 152 (37.6%) were positive. 174 strains were isolated from the 152 positive specimens, 96 (55.2%) gram-negative, 70 (40.2%) gram-positive and 8 (4.6%) fungal strains. Compared to the pancreatic fluid culture-negative group, patients in the pancreatic fluid culture positive group had a statistically significant ( P<0.05) increased risk of neutrophil to lymphocyte ratio, duration of fever, Balthazar CT score, complication rate, and development of pancreatic necrosis, pancreatic infection and systemic inflammatory response syndrome (SIRS). Compared to patients in the non-pancreatic infection group, patients in the pancreatic infection group had a statistically significant ( P<0.05) increase in duration of fever on admission, duration of fasting, and proportion of patients with combined SIRS, positive bile cultures, positive pancreatic fluid cultures, and diabetes mellitus. Logistic regression analysis showed that positive pancreatic fluid cultures ( OR=6.699, 95% CI: 1.159-38.725) and diabetes mellitus on admission ( OR=4.625, 95% CI: 1.304-16.394) were risk factors for late pancreatic infection ( P<0.05). The area under the ROC curve for the combination of both positive pancreatic fluid culture and diabetes mellitus in predicting late pancreatic infection in patients was 0.788, with a specificity of 59.30% and a sensitivity of 90.00%. Conclusions:Bacterial culture in pancreatic juice and bile of ABP patients showed mainly Gram-negative bacteria. Early culture of pancreatic juice and bile had positive significance in ABP evaluation, infection prediction and anti-infection treatment.

Application of abnormal cell-free DNA methylation in pancreatic juice in the early diagnosis of pancreatic cancer / 临床肝胆病杂志

Pancreatic cancer is a digestive system tumor with insidious onset, high malignancy, and difficult diagnosis, and early diagnosis is the key to improving the survival rate and prognosis of patients with pancreatic cancer. This article introduces the research advances in abnormal methylation of cell-free DNA in pancreatic juice and the early diagnosis of pancreatic cancer, and it is believed that the detection of cell-free DNA methylation in pancreatic juice may be an effective method for the early diagnosis of pancreatic cancer.

Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer

BACKGROUND/AIMS: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.METHODS: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.RESULTS: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.CONCLUSIONS: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.

Pancreatic Compression during Lymph Node Dissection in Laparoscopic Gastrectomy: Possible Cause of Pancreatic Leakage

PURPOSE: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. MATERIALS AND METHODS: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. RESULTS: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. CONCLUSIONS: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

Determination of linezolid in human serum, cerebrospinal fluid and pancreatic juice by HPLC / 中国药学杂志

OBJECTIVE To develop a high-performance liquid chromatographic (HPLC) method for determination of linezolid in human serum, cerebrospinal fluid (CSF) and pancreatic juice. METHODS: With risperidone as internal standard, samples were extracted by methyl tert-butyl ether-repropanol=90:10 (V/V) after added 0.1 mol·L-1 NaOH, then seperated on a Shima-pack CLC-ODS-C18 (6.0 mm ×150 mm, 5 μm) column with mobile phase consisted of methanol-acetonitrile-phosphate buffer solution (0.02 mol·L-1 KH2PO4, PH value was adjusted to about 3.5 by H3PO4)=20:16:64(V/V/V) with a flow rate of 1.0 mL·min-1 at 35℃. Fhe detection wavelength was set at 254 nm. RESULTS: For serum, the linear range of linezolid was from 0.25 to 40.0 mg·L-1 (r=0.999 9). For the three check samples (0.8, 8.0, 25.0 mg·L-1): the intra-run and inter-run RSDs were 1.64%-2.38% (n=5) and 4.53%-6.34% (n=5) respectively, the mean method recoveries and extraction recoveries were 93.781%-97.393% (n=5) and 72.318%-73.442% (n=5) respectively. For cerebrospinal fluid, the linear range of linezolid was from 0.1 to 20.0 mg·L-1 (r=0.999 3). For the three check samples (0.2, 2.0, 15.0 mg·L-1): the intra-run and inter-run RSDs were 3.84%-4.83% (n=5) and 6.04%-8.16% (n=5) respectively, the mean method recoveries and extraction recoveries were 106.910%-110.971% (n=5) and 73.226%-80.603% (n=5) respectively. For pancreatic juice, the linear range of linezolid was from 0.1 to 20.0 mg·L-1 (r=0.999 4). For the three check samples (0.2, 2.0, 15.0 mg·L-1); the intra-run and inter-run RSDs were 2.96%-5.30% (n=5) and 4.68%-6.40% (n=5) respectively, the mean method recoveries and extraction recoveries were 97.178%-105.072% (n=5) and 73.333%-76.010% (n=5) respectively. The mean extraction recoveries of IS were more than 87.00%. CONCLUSION: The method is sensitive, simple and accuracy, and it can be used for clinical study, espicially used in the patient with drag combination.

Effects of reinfusion of external drained bile and pancreatic juice on the outcome of pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the effect of reinfusion of drained bile and pancreatic juice on the outcome of pancreaticoduodenectomy (PD).Methods The clinical data of 51 patients who received PD at the Affiliated Hospital of Binzhou Medical College from June 2005 to March 2009 were retrospectively analyzed.Nineteen patients received external drainage of bile and pancreatic juice ( ED group) and the other 32 patients received external drainage and intraintestinal administration of autologous bile and pancreatic juice (ID group).The daily volume of output of bile and pancreatic juice,intraoperative condition,tolerance of enteral nutrition,liver function and nutritional parameters of the 2 groups were detected.All data were analyzed by using chi-square test,Fisher exact test,independent t test,Mann-Whitney U test and one-way analysis of variance.Results The pulmonary infection rate of ID group was 3％ (1/32) after operation,which was significantly lower than 26％ (5/19) of the ED group (P ＜ 0.05).The output of pancreatic juice in the ID group was significantly lower than that in the ED group since postoperative day 4 ( t =7.143,9.244,8.808,7.915,6.461,14.097,15.038,P ＜ 0.05 ).There was no significant difference in the daily output of bile between the 2 groups.The incidence of diarrhea in the ID group was 9％ (3/32) after nutritional support,which was significantly lower than 37％ (7/19) of ED group (P＜0.05).The duration of achieving targeted enteral feeding in the ID was 3 days,which was significantly shorter than 4 days of the ED group ( U =145.000,P ＜ 0.05 ).The levels of total bilirubin ( TBil),direct bilirubin (DBil) and indirect bilirubin (IBil) were (261 ± 108 ),( 132 + 55 ) and ( 129 + 55 ) μmol/L in the ID group,and (239 ±92),( 12A ±46) and ( 116 ±46) μmol/L in the ED group before operation.The levels of TBil,DBil and IBil were (39 ± 19),(20 ± 10) and ( 19 +9) μmol/L in the ID group,and (55 ±22),(29 ± 12) and (26 ±11 ) μmol/L in the ED group at 12 days after nutritional support.There were significant differences in the decrease of TBil,DBil and IBil between the 2 groups ( t =7.324,8.437,5.827,P ＜ 0.05 ).The levels of serum prealbumin,retinol binding protein and transferrin were (0.261 ± 0.021 ) g/L,(34.3 ± 2.8 ) mg/L,(3.08 + 0.26 ) g/L in the ID group,and (0.263 ±0.021)g/L,(33.8 +3.5)mg/L and (3.10 +0.27)g/L in the ED group before operation.The levels of serum prealbumin,retinol binding protein and transferrin decreased significantly after operation,and then got increased 3 days after nutritional support.The levels of serum albumin,retinol binding protein and transferrin were (0.238 ±0.025)g/L,(30.7 ±2.0)mg/L,(2.78 ±0.19)g/L in the ID group,and (0.222 +0.025)g/L,(29.3 ±2.1)mg/L and (2.63 +0.21)g/L in the ED group at 12 days after nutritional support.The levels of serum albumin,retinol binding protein and transferrin in the ID group were significantly higher than those in the ED group (t=4.615,6.097,4.913,P＜0.05).Conclusion Reinfusion of external drained bile and pancreatic juice after PD could enhance the tolerance of patients in early enteral nutrition,reduce incidence of pneumonia,promote decrease of serum bilirubin and improve the nutritional status.

Establishment of an animal model of pancreatic juice reflux esophagitis / 中华胰腺病杂志

Objective To establish an animal model of pancreatic juice reflux esophagitis, and compare the roles of single pancreatic juice with pancreatic juice plus bile acids reflux in the pathogenesis of gastroesophageal reflux disease (GERD). Methods Fifty SD rats were randomly divided into 3 groups, group A: gastrectomy and end- to- side esophagojejunostomy (pancreatic juice and bile combination group, n=20); group B, gastrectomy and end-to-side esophagojejunostomy and bile-duct-jejunostomy (single pancreatic juice group, n = 20 ); group C: simple laparotomy ( n = 10). The rats were sacrificed 1, 2, 4 weeks after operation, and the change of weight of the rats and esophageal morphology was observed. Results Four rats in combination group died during or after operation, and the success rate of the model was 80%, 6 rats in single pancreatic juice group died, and the success rateof the model was 70%, both group A and B rats lost more weight significantly than that in control group, and the weight gradually increased 2 weeks later, but it was still lower than that in control group [(218 ±21), (216 ±20)g vs. (286 ±28)g, P＜0.05]. Reflux esophagitis of different degree was present in both groups, which was more severe in the lower part of esophagus, and severity increased with time. The main histologic changes were inflammation, erosion, ulcer and epithelial cell hyperplasia and metaplasia. The severity of esophagitis was not significantly different between group A and group B. Conclusions The models of single pancreatic juice reflux esophagitis can be successfully made. It establishes the foundation for experimental research of pancreatic juice induced esophageal mucosa injury.

Aberrant methylation of CpG island in 5′ promoter region of p16 gene and its role in diagnosis of pancreatic cancer / 第二军医大学学报

Objective: To investigate the aberrant methylation of CpG island in 5′ promoter region of p16 gene in the pancreatic juice and its value in diagnosis of patients with pancreatic cancer. Methods: Pure pancreatic juice(PPJ) was collected from the pancreatic duct by a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography (ERCP). Cytological examination was performed by H-E staining in pure pancreatic juice. Aberrant p16 methylation was detected using the methylation-specific PCR (MSP) in the PPJ. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy cytological examination in diagnosis of pancreatic cancer were 40%, 100%, 100%, 45.4% and 60.0%, respectively. The DNA sequences were successfully extracted from the PPJ of 30 patients with pancreatic diseases and were subjected to MSP. Seven(35%) of the 20 cases with pancreatic cancer showed aberrant methylation of p16 gene. No aberrant methylation was detected in the pancreatic juice samples of patients with chronic pancreatitis and mucinous cystoadenocarcinoma of pancreas. When cytological examination combined with p16 methylation detection, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for diagnosis of pancreatic cancer were 55%, 100%, 100%, 52.6% and 70%, respectively. Conclusion: Pancreatic juice collected by nasopancreatic drainage during ERCP can be used for molecular analysis. Detection of aberrant methylation of p16 gene in pancreatic juice combined with cytological examination is a better method for diagnosis of pancreatic cancer.

Methylation analysis of human hedgehog interacting protein gene in pancreatic juice / 中华胰腺病杂志

nd hypermethylation of HHIP was detected in pancreatic juice,which may be a useful marker in the diagnosis of PCa.

Occult pancreatobiliary reflux / 中华普通外科杂志

Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopanereatography (ERCP), bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobihary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701±20 378 IU/L and 16±51 IU/L, respectively ( P <0. 01 ).Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliaryreflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux ( P <0. 05). In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder dysplasia or cancer (P < 0. 01 ). Conclusions With an incidence of 9.9% in patients of normal pancreatobiliary junction,the occult pancreatobihary reflux may contribute to the pathogenesis of gallbladder epithelial dysplasia and cancer.

Differential proteomic analysis of pancreatic juice in pancreatic cancer patients / 中华消化杂志

Objective To analyze the differential expression of proteins among patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis in order to find potential biomarkers for diagnosis of pancreatic cancer and to differentiate pancreatic cancer from chronic pancreatitis. Methods The pancreatic juice were connected from 5 pancreatic cancer patients,6 chronic pancreatitis patients and 3 choledocholi-thiasis patients by naso-pancreatic drainage using endoscopic retrograde cholanglopancreatography(ERCP).The proteins in pooled pancreatic juice were separated by two-dimensional gel electrophoresis (2-DE).The differential expression of proteins were analyzed by image analysis software and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS).Results ①There were 35-200 ml of pancreatic juice collected,and protein concentration were ranged from 0.8 to 4.6 μg/μl.The 2-DE showed that the protein spots in pancreatic cancer,chronic pancreatitis and choledocholithiasis juice were 196±12,209±15 and 199±10,respectively.The matched proteins among three groups all exceeded 75%.②MALDI-TOF-MS revealed that the expression of chain A of a covalent dimer of transthyretin in pancreatic cancer was up-regulated(＞2-fold)while the expressions of chain A of crystal structure of lipid-free human apolipoproteinA-1,chain of human lithostathin and regenerating islet-derived 1 beta precursor were down-regulated. Conclusions Protein spectra are different in patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis.Transthyretin,apolipoproteinA-1,human lithostathin and regenerating islet-derived 1 beta might be the biomarkers of human pancreatic cancer and may be useful in distinguishing pancreatic cancer from chronic panceatitis.

An Analysis on the Amount of Excreted Pancreatic Juice after Pancreatoduodenectomy / 대한소화기학회지

BACKGROUND/AIMS: There has been lack of data on the secretion of the pancreatic juice after pancreatoduodenectomy. Thus, surgeons have difficulties in predicting the clinical sequences of pancreaticojejunostomy leakage or other pancreatic surgery. METHODS: This study employed 15 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD) with total external drainage of the pancreatic duct from January 2000 to June 2001. RESULTS: These patients were divided into the normal pancreas group (n=11) and chronic pancreatitis- accompanied group (n=4). Excretion of pancreatic juice was suppressed in a few days after PPPD. Then, it gradually increased and became constant at the postoperative day 4. The amount of excreted pancreatic juice in the normal pancreas group was 229 +/- 99, 85~385 (mean, range) mL/day at the postoperative day 7 before the initiation of oral intake, and was increased to 314 +/- 222, 110~910 (mean, range) mL/day at the 7th day after the initiation of food intake. The usage of octreotide during early fasting period had no influence on the excretion of the pancreatic juice in the normal pancreas group. CONCLUSIONS: We observed the real amount of secreted pancreatic juice after PPPD. These data may be helpful to interpret and manage the postoperative conditions such as pancreatic leakage or pancreatic exocrine insufficiency.

Clinical Analysis of the New Handling Method of Pancreatic Cut Surface in Pancreatoduodenectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Pancreatoduodenectomy is a common procedure for benign or malignant periampulary diseases. But the morbidity and mortality of the procedure are usually high. Being related with morbidity and mortality, the most important procedure of pancreatoduodenectomy is how handle the remnant pancreas. We analysed retrospectively the efficiency of the new method for low morbidity and low mortality in handling of the remnant pancreas in the procedures of pancreatoduodenectomy. METHODS: 118 consecutive patients who had undergone a pancreatoduodenectomy and pancreaticojejunostomy performed by one surgeon, between September 1994 and June 1999, were evaluated retrospectively. The cases were analysed by age, sex, pathologic dianosis, operation time, the amount of transfusion during operation, the hospital stay, postoperative complications and state of survival. RESULTS: The average age of 118 patients was 57.6 years, and the male and female ratio was 1.19:1. The classification by patholoic diagnoses were distal common bile duct cancers (29%), the ampulla of Vater cancers (23%), the pancreas head cancers (14%), the duodenal cancers (1.7%) and the others (32%) including benign diseases. The average operation time was 8 hours 3 minutes, the average amount of transfusion was 0.84 unit and the average hospital stay was 26.1 days. There are 12 (10.2%) postoperative complications. The most were 6(5%) cases of delayed gastric emptying, and the others were 2 (1.7%) cases of leakage of pancreaticojejunostomy, 1 (0.8%) case of ARDS, 1 (0.8%) case of gastroduodenal artery bleeding, 1 (0.8%) case of remnant pancreas bleeding, and 1 (0.8%) case of pseudoaneurysmal bleeding of gastroduodenal artery. The 2 cases of leakage of pancreaticojejunostomy developed at the patients of duodenal cancer and ampulla of Vater cancer. The patient who diagnosed by ampulla of Vater cancer died for sepsis due to leakage of the pancreaticojejunostomy (1/118, 0.8%). CONCLUSION: We had good results in pancreatoduodenectomy and pancreaticojejunostomy by a new method that protect the anastomotic leakge from pancreaticojejunostomy site. This method include pancreas transection by elctrocoagulation, not doing sutures of remnant pancreas to prevent ischemic change of pancreatic cut surface and complete drainage of pancreatic juice using stent that was inserted at remnant pancreatic duct and externally ligated by vicryl with keeping the lumen.

Detection of K-ras gene mutation in pancreatic juice for diagnasis of pancreatic cancer:a meta-analysis / 中国普通外科杂志

Objective To systematically assess the detection of K-ras gene mutation at codon 12 in pancreatic juice for diagnosis of pancreatic cancer.Methods A comprehensive electronic searching was performed to retrieve relevant studies on K-ras gene mutation in pancreatic juice for diagnosis of pancreatic cancer.Data on accuracy of included studies were extracted,Meta-DiSc1.4,Stata10.0,was applied for further heterogeneity exploring,meta-analysis and publication bias testing.Results Fifteen studies met the inclusion criteria.Heterogeneity was not found among these studies,including threshold effect,different test methods,randomization and blind.Pooled accuracy indicators like sensitivity,specificity and diagnostic odds ratio(DOR) were 0.61(95%CI 0.56-0.66),0.82(95%CI 0.77-0.86) and 6.28(95%CI 4.42-8.91),respectively.Area under curve(AUC) of SROC(summary receiver operating characteristics) was 0.8207 and Q index was 0.7542.Publication bias had little influence on meta-analysis with the fail-safe number of 694.0108.Conclusions This meta-analysis demonstrates that the detection of K-ras gene mutation in pancreatic juice has moderate effect for diagnosis of pancreatic cancer.It is not enough to be an early diagnosing or screening indicator for pancreatic cancer,but it can be used clinically as an important adjunct to cytology,imageology and enzymology in the diagnosis of pancreatic cancer.

Detection of the expression of hTERT mRNA and telomerase activity of pancreatic juice in the diagnosis of pancreatic cancer / 中国普通外科杂志

Objective To study and evaluate the diagnostic and differencial diagnostic value of detection of human telomerase reverse transcriptase(hTERT) mRNA and telomerase activity in pancreatic juice of (pancreatic) cancer(PC) .Methods hTERT mRNA expression and telomerase activity in pancreatic juice in 24 cases of (pancreatic) cancer and 14 cases of chronic pancreatitis(CP) were detected and compared.Results Expression of hTERT mRNA was detected in 87 .5% (21/24) of PC cases and 21.4%(3/14) of CP cases(P

Analysis of human pancreatic juice in tests of pancreatic function

No abstract available.

Usefulness of Intraductal Secretin Test in Assessing Exocrine Pancreatic Function in Patients with Chronic Pancreatitis / 대한소화기내시경학회지

BACKGROUND/AIMS: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation of the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. METHODS: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. RESULTS: When we regarded mean-1.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. CONCLUSIONS: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.

Tumor Marker Study of Pure Pancreatic Juice in Patient with Pancreatic Diaeases / 대한소화기내시경학회지

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.

Collection and Analysis of Pure Pancreatic Juice via Duodenoscopie Cannulation / 대한소화기내시경학회지

The recent development of endoscopic retrograde cholangiopancreatography (ERCP) now permits the collection of pure human pancreatic secretions via duodenoscopic cannulation. Study objectives are evaluation of exocrine pancreatic function and analysis of pure pancreatic juice collected by use of ERCP technique in subjects without pancreatic disease. From March to July 1993, we performed ERCP and collection of pure pancreatic juice in 10 patients without evidence of pancreatic disease. (continue...)

Aberrant methylation of CpG island in 5′promoter region of p16 gene and its role in diagnosis of pancreatic cancer / 第二军医大学学报

Objective:To investigate the aberrant methylation of CpG island in 5′promoter region of p16 gene in the pancreatic juice and its value in diagnosis of patients with pancreatic cancer.Methods:Pure pancreatic juice(PPJ)was collected from the pancreatic duct by a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography(ERCP). Cytological examination was performed by H-E staining in pure pancreatic juice.Aberrant p16 methylation was detected using the methylation specific PCR(MSP)in the PPJ.Results:The sensitivity,specificity,positive predictive value,negative predictive value and accuracy cytological examination in diagnosis of pancreatic cancer were 40%,100%,100%,45.4% and 60.0%,respectively.The DNA sequences were successfully extracted from the PPJ of 30 patients with pancreatic diseases and were subjected to MSP.Seven(35%)of the 20 cases with pancreatic cancer showed aberrant methylation of p16 gene.No aberrant methylation was detected in the pancreatic juice samples of patients with chronic pancreatitis and mucinous cystoadenocarcinoma of pancreas.When cytological examination combined with p16 methylation detection,the sensitivity, specificity,positive predictive value,negative predictive value and accuracy for diagnosis of pancreatic cancer were 55%,100%, 100%,52.6% and 70%,respectively.Conclusion:Pancreatic juice collected by nasopancreatic drainage during ERCP can be used for molecular analysis.Detection of aberrant methylation of p16 gene in pancreatic juice combined with cytological examination is a better method for diagnosis of pancreatic cancer.