Pancreatic carcinoma. Diagnostic and prognostic implications of a normal pancreatogram.

BACKGROUND The aim of this study was to establish the implications of a normal pancreatogram in patients with pancreatic cancer. METHODS We reviewed all ERCP done at our institution for the period 1983-92 and studied 62 of 727 patients who had a diagnosis of pancreatic (n = 416) or biliary (n = 311) cancer but a normal pancreatic duct. RESULTS Thirty of the 62 patients had pancreatic cancer. In 15 cases, the ERCP diagnosis was incorrect, and in 19 cases, Santorini's duct was not visualized. Other imaging revealed a pancreatic head mass in 25 patients (2.5->7 cm). Only three patients had resectable tumors; another eight underwent laparotomy. Five had bypass surgery, 10 required biliary stenting, and nine had no treatment. Four patients died in hospital, and eight were lost to follow-up. In the remaining 18 patients, median survival was 7 months (range, 1-30 months). CONCLUSION A normal pancreatogram does not exclude the diagnosis of pancreatic cancer, nor does it confer a better prognosis.

[1]  C. Garberoglio,et al.  Pancreatic adenocarcinoma: an update. , 1996, Journal of the American College of Surgeons.

[2]  D. Carter.  Cancer of the pancreas. , 1988, Gut.

[3]  Freeny Pc.  Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. , 1989 .

[4]  I. Marks,et al.  Diagnostic yield of endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas , 1986, The British journal of surgery.

[5]  C. Frey,et al.  Endoscopic retrograde cholangiopancreatography. , 1982, American journal of surgery.

[6]  T. Ball,et al.  Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: Diagnostic limitations and contemporary roles , 1981, Cancer.

[7]  J. Wittenberg,et al.  Modern concepts of imaging of the pancreas. , 1980, Investigative radiology.

[8]  J. Malagelada.  Pancreatic cancer: an overview of epidemiology, clinical presentation, and diagnosis. , 1979, Mayo Clinic proceedings.

[9]  P. Cotton,et al.  Endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas. , 1979, Surgery, gynecology & obstetrics.

[10]  R. Katon,et al.  "Blind" evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: the "double duct" and other signs. , 1976, Radiology.

[11]  J. Vennes,et al.  Diagnostic accuracy of endoscopic retrograde cholangiopancreatography in hepatic, biliary, and pancreatic malignancy. , 1976, Annals of internal medicine.