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Santorinicele: secretin-enhanced magnetic resonance cholangiopancreatography findings before and after minor papilla sphincterotomy

  • Gastrointestinal
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Abstract

Objectives

To evaluate secretin-enhanced MRCP (S-MRCP) findings of patients with pancreas divisum and Santorinicele, before and after minor papilla sphincterotomy.

Methods

S-MRCP examinations of 519 patients with suspected pancreatic disease were included. Size of the main pancreatic duct, presence and calibre of Santorinicele were evaluated. Duodenal filling was assessed on dynamic images. After sphincterotomy the same parameters and the clinical findings were re-evaluated.

Results

Pancreas divisum was depicted in 55/519 patients (11 %) by MRCP and an additional 26/519 by S-MRCP (total 81/519, 16 %). Santorinicele was detected in 7/81 patients (8.6 %) with pancreas divisum by MRCP and an additional 20/81 by S-MRCP (total 27/81, 33 %). Dorsal duct in patients with Santorinicele was significantly larger in the head compared with patients with only pancreas divisum (p < 0.01), in basal conditions (average 2.4 versus 1.9 mm) and after secretin administration (average 3.0 versus 2.4 mm). Duodenal filling was impaired in 11/27 patients (41 %) with Santorinicele. After sphincterotomy significant reduction in size of Santorinicele (−33 %) and dorsal duct (−17 %), increase of pancreatic juice and symptoms improvement were observed.

Conclusion

Secretin administration increases the accuracy of MRCP in detecting Santorinicele and demonstrates the impaired duodenal filling. S-MRCP is useful to assess results of sphincterotomy.

Key Points

• Secretin-enhanced MRCP gives anatomical and functional information on pancreatic outflow dynamics.

• Santorinicele is a cystic dilatation of the termination of the Santorini duct.

• S-MRCP images are the most useful to recognize the presence of Santorinicele.

• Minor papilla sphincterotomy during ERCP is indicated in patients with Santorinicele.

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Acknowledgments

The scientific guarantor of this publication is Roberto Pozzi Mucelli. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. The authors consulted a colleague (William Mantovani, MD, Department of Statistic, Policlinico G.B. Rossi, Verona) with significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology - Policlinico G.B. Rossi, University of Verona, P.le L.A. Scuro 10, Verona, Italy

    Enrico Boninsegna, Riccardo Manfredi, Anna Ventriglia, Riccardo Negrelli, Beatrice Pedrinolla, Sara Mehrabi & Roberto Pozzi Mucelli

  2. Department of Medicine - Policlinico G.B. Rossi, University of Verona, Verona, Italy

    Armando Gabbrielli

Authors
  1. Enrico Boninsegna
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  2. Riccardo Manfredi
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  3. Anna Ventriglia
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  4. Riccardo Negrelli
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  5. Beatrice Pedrinolla
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  6. Sara Mehrabi
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  7. Armando Gabbrielli
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  8. Roberto Pozzi Mucelli
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Correspondence to Enrico Boninsegna.

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Boninsegna, E., Manfredi, R., Ventriglia, A. et al. Santorinicele: secretin-enhanced magnetic resonance cholangiopancreatography findings before and after minor papilla sphincterotomy. Eur Radiol 25, 2437–2444 (2015). https://doi.org/10.1007/s00330-015-3644-0

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  • DOI: https://doi.org/10.1007/s00330-015-3644-0

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