Evaluation of duodenal papillary function by ERCP-CT and comparison with endoscopic measurement of pressure in the papillary sphincter zone.

Abstract

Imaging of the main pancreatic duct on ERCP-CT (computerized tomography performed immediately after endoscopic retrograde cholangiopancreatography) was evaluated in 192 patients. Favorable images were obtained in elderly patients, as well as in those with main pancreatic duct dilation, chronic pancreatitis, papillary disease, and choledocholithiasis. In addition, we used a microtransducer inserted through a duodenoscope to measure papillary sphincter zone and main pancreatic duct pressure. We then compared the endoscopic results with the images achieved on ERCP-CT. The patients with favorable images showed higher pancreatic and papillary basal pressure and a faster wave cycle than those with poor images. In addition, significant differences in pancreatic duct pressure and basal pressure were seen. Peak papillary pressure showed no consistent correlations with imaging. Patients with favorable images exhibited an increase in the frequency of irregular papillary sphincter zone waves. We conclude from these findings that good images on ERCP-CT reflect a slow flow of pancreatic juice, which is closely associated with papillary stenosis.