内視鏡下留置バルーンカテーテルによる膵管充満造影法―背臥位圧迫撮影の膵精査における有用性

Endoscopic Balloon Catheter Pancreato-graphy Using Catheter Retaining Technique: Usefulness of supine spot films by compression for complete evaluation of pancreatic ducts and branches

要旨　内視鏡的逆行性膵管造影（ERP）の診断能を向上させる目的で，内視鏡下留置バルーンカテーテルによる膵管充満造影法（バルーンERP）を開発した．膵疾患と下部胆管癌の計48例に本法を試み，45例に成功した．同45例中，ERP像とバルーンERP像の対比可能な35例につき両者の膵管描出能を検討した．その結果，確診可能な，鮮明な膵管充満像は，バルーンERP像で29例（83％）に得られたが，ERP像ではわずか5例にすぎなかった．また，組織判明例25例で両者の診断能を比較検討したところ，バルーンERP像により半数近くの11例に診断能の向上をみた．特に背臥位圧迫撮影が，膵管像の鮮明化と病変部の描出に優れ，診断能の向上に寄与した．

　In an attempt to improve diagnostic ability of endoscopic retrograde pancreatography (ERP), a balloon catheter retained in the pancreatic duct by duodenoscopy was used in 48 patients with pancreatic diseases or carcinoma of the distal bile duct. Cannulation and retaining of the catheter were successful in 45 patients. The result of balloon catheter ERP was compared with that of standard ERP in 35 patients where both were available for detailed analysis. Balloon catheter ERP clearly visualized the lesion and thus permitted definite diagnosis in 29 of these patients (83%), whereas standard ERP allowed definite diagnosis in only 5 patients (14%). Histological diagnosis was obtained in 25 of the 35 patients. Comparison of diagnostic ability between balloon catheter ERP and standard ERP in these 25 patients demonstrated that the balloon catheter method was better in 11 patients. Supine spot films by compression, obtainable only by the procedure described in this report, were found to be quite useful both to fully visualize the lesion and to make the pancreatogram clear. We conclude that the use of a retained balloon catheter would improve diagnostic potential of ERP.