DIRECT MAGNIFICATION DURING ERCP:Discrimination between Carcinoma of the Pancreas and Chronic Pancreatitis by the Use of Convex Type and Concave Type in ERCP

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The branches and fine pancreatic ducts when opacified with contrast material can be studied more precisely after direct fourfold magnification during ERCP than by routine ERCP.Routine post-mortem pancreatograms (PMP) and direct fourfold magnification during PMP (PMPM) were compared in 16 cases. Greater accuracy was obtained by the latter method resulting in an increase of abnormal areas and a twofold increase in the number of branches of the pancreatic ducts that could be analysed.ERCP and direct fourfold magnification during ERCP (ERCPM) were performed in 30 subjects. Twenty-six pairs of ERCP and ERCPM were obtained. These 26 cases included 4 cases of pancreatic carcinoma, 21 of chronic pancreatitis and one normal. Good filling during ERCPM gave more information in 22 cases than during ERCP. In 3 subjects ERCPM was particular value in the diagnosis of pancreatic disease. ERCPM revealed localized pancreatitis in two patients in whom there was a suspicion of pancreatic carcinoma at ERCP. There was no advantage of ERCPM in 3 cases because of a large carcinoma of the pancreas, but particular advantages were found in one case with a small carcinoma.Encasement of the pancreatic ducts might be characterized as convex from the side of lumen in carcinoma of the pancreas, i.e., convex type, whereas it might be characterized as concave from the side of lumen in chronic pancreatitis, i.e., concave type. Significant discrimination was obtained between carcinoma of the pancreas and chronic pancreatitis by the use of these types not only in PMPM and ERCPM but also in PMP and ERCP.
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DIRECT MAGNIFICATION DURING ERCP:Discrimination between Carcinoma of the Pancreas and Chronic Pancreatitis by the Use of Convex Type and Concave Type in ERCP

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