Background and Aims

Annular pancreas is a congenital anomaly whereby pancreatic tissue encircles the duodenum. Current knowledge of endoscopic findings of annular pancreas is limited to small case series. The aim of this study was to describe the endoscopic and pancreatographic findings of patients with annular pancreas at a large tertiary care ERCP center.

Methods

This is a retrospective observational study. Our Institutional Review Board–approved, prospectively collected ERCP database was queried for cases of annular pancreas. The electronic medical records were searched for patient and procedure-related data.

Results

From January 1, 1994, to December 31, 2016, 46 patients with annular pancreas underwent ERCP at our institution. Index ERCP was technically successful in 42 patients (91.3%), and technical success was achieved in all 46 patients (100%) after 2 attempts, when required. A duodenal narrowing or ring was found in most patients (n = 39, 84.8%), yet only 2 (4.3%) had retained gastric contents. Pancreas divisum was found in 21 patients (45.7%), 18 of which were complete divisum. Pancreatobiliary neoplasia was the indication for ERCP in 7 patients (15.2%). Pancreatographic findings consistent with chronic pancreatitis were noted in 15 patients (32.6%) at the index ERCP.

Conclusion

This is the largest series describing the endoscopic and pancreatographic findings of patients with annular pancreas. We found that 45.7% of patients had concurrent pancreas divisum. Endoscopic therapy was successful in most patients at our institution after 1 ERCP, and in all patients after a second ERCP. Nearly one-third of patients had findings consistent with chronic pancreatitis at the time of index ERCP. It is unclear whether this may be a feature of the natural history of annular pancreas.

中文翻译：

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环状胰腺：第三次转诊ERCP中心的内镜和胰腺检查结果

背景和目标

环状胰腺是先天性异常，胰腺组织环绕十二指肠。环形胰腺内窥镜检查的当前知识仅限于小病例系列。这项研究的目的是描述一家大型三级护理ERCP中心的环形胰腺患者的内镜和胰腺影像学发现。

方法

这是一项回顾性观察研究。查询了我们机构审查委员会批准的，预期收集的ERCP数据库中的环状胰腺病例。在电子病历中搜索患者和与手术相关的数据。

结果

从1994年1月1日至2016年12月31日，我们机构对46例环形胰腺患者进行了ERCP。必要时，ERCP指数在42例患者（91.3％）中取得了技术上的成功，在两次尝试后，全部46例患者（100％）获得了技术上的成功。在大多数患者中发现十二指肠变窄或呈环形（n = 39，84.8％），但只有2个（4.3％）保留了胃内容物。胰脏分裂被发现21例（45.7％），其中18例完全分裂。胰胆管肿瘤是7例（15.2％）ERCP的指征。ERCP指数显示15例患者（占32.6％）与慢性胰腺炎相符。

结论

这是描述环形胰腺患者的内窥镜检查和胰腺检查结果的最大系列文章。我们发现45.7％的患者并发胰腺分裂。内镜治疗在我们机构的大多数患者中接受了1次ERCP后均获得成功，而在所有患者中接受了第二次ERCP后均获得了成功。ERCP指数出现时，近三分之一的患者发现与慢性胰腺炎相符。尚不清楚这是否可能是环状胰腺自然病史的特征。