PATENCY OF THE HUMAN ACCESSORY PANCREATIC DUCT AS DETERMINED BY DYE-INJECTION ENDOSCOPIC RETROGRADE PANCREATOGRAPHY

The accessory pancreatic duct (APD) is the smaller and less constant p ancreatic duct. The patency of the APD was investigated clinically in an effort to determine its role in pancreatic pathophysiology. Dye-inj ection endoscopic retrograde pancreatography (ERP) was performed in 19 0 cases. In the patients who exhibited filling of the fine branches of the ducts on ERP, contrast medium with indigo carmine was injected in to the major duodenal papilla. The patency of the APD was determined b y observing the excretion of the dye from the minor duodenal papilla. Of the 123 control cases studied, 41% had a patent APD. According to t he shape of the terminal portion of the APD on accessory pancreatogram , it was classified as either the stick type (n = 63), branch type (n = 15), saccular type (n = 15), spindle type (n = 11), or cudgel type ( n = 8). In these groups, 49, 0, 27, 82, and 87% of the APD were patent , respectively. The patency of the APD in the patients with acute panc reatitis was 6% (1 of 17). The difference in patency between this grou p and the control group was significant (p < 0.01). The patency of the APD varies with the shape of the terminal portion of the APD. A paten t APD may prevent acute pancreatitis by lowering the pressure in the m ain pancreatic duct.