Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis.

The integrity of the main pancreatic duct (MPD) was evaluated by endoscopic retrograde pancreatography (ERP) in a retrospective study of 105 patients with acute pancreatitis presenting over an 11-year period (1980-1991). The findings were compared with clinical outcome and the need to operate for local pancreatic complications. Patients were divided into two groups. Group 1 (n = 89) had either clinically mild pancreatitis or severe disease but no surgery for local complications, and < 25 per cent necrosis on contrast-enhanced computed tomography (CT) (n = 48). Group 2 patients (n = 16) had clinically severe pancreatitis and underwent surgery for local complications and/or had > or = 25 per cent necrosis on CT (n = 12), at surgery or post mortem. All 89 patients in group 1 had an intact MPD at ERP, which was performed a median of 6 (range 0-30) days after onset of pancreatitis; the median age was 63 (range 20-88) years and there were no deaths. The median age of patients in group 2 was 59 (range 26-85) years. ERP in this group was performed in four patients < 5 days after onset and all had an intact MPD; one died with necrosis and another from a cerebrovascular accident. ERP was performed > or = 5 days after onset in the other 12 patients; five had an intact MPD and two required surgery for pseudocyst drainage only; seven had a disrupted MPD and all required surgery for pancreatic necrosis (one death). It is concluded that an intact MPD was a feature of mild pancreatitis, whereas disruption occurred > 4 days after onset in patients with necrosis necessitating surgery.