Thamarai Selvan, Sivagnanam (2006) Role of Endoscopic Retrograde Cholangio Pancreatography in Tropical Calcific Pancreatitis. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION : Tropical Calcific Pancreatitis (TCP) is the most common type in India and China, accounting for 60 – 70% of all Chronic Pancreatitis. This is in contrast with developed countries where Alcohol related Pancreatitis accounts for most of the cases of Chronic Pancreatitis. Tropical Calcific Pancreatitis is generally a disease of youth and early adulthood. It is found in areas with in 30 degrees of latitude on both sides of the equator. Pancreatitis is the most common mode of presentation in 70 – 100% of patients. Later in the course, patients may present with diabetes mellitus, maldigestion and weight loss. Pathologically Tropical Calcific Pancreatitis is characterized by large intra ductal calculi, marked dilatation of main duct and glandular atrophy. Its etiology is not known. High level of consumption of cassava which contains toxic glycosides is attractive hypothesis but not proved yet. Two recent studies have reported that a significant percentage of patients with Tropical Calcific Pancreatitis have spink mutation . Endoscopic Retrograde Cholangio Pancreatography (ERCP), the secretin stimulation test and Endoscopic Ultrasound (EUS) have all been suggested as a gold standard for the diagnosis of Chronic Pancreatitis. The management of Tropical Calcific Pancreatitis involves managing pain, diabetes and steatorrhoea. MATERIALS AND METHODS : A total of 123 consecutive patients (103M: 20F) in the age group of 13-54 years (mean age 29.8 years), diagnosed as Tropical Calcific Pancreatitis(TCP) in a tertiary referral centre for gastroenterological and hepatobiliopancreatic disorders. Patients referred and diagnosed as TCP by clinical, radiological, biochemical, Ultrasonographic, CAT Scan Evaluation (in selected cases) underwent diagnostic ERCP between Jan 2000 to Dec 2003 in purview of therapeutic ERCP. CONCLUSIONS : 1. Tropical Calcific Pancreatitis is a very fertile area for applying different Endoscopic Retrograde Cholangio Pancreatographic interventions. 2. Diagnostic Endoscopic Retrograde Cholangio Pancreatography provides a road map for planning for different endotherapeutic procedures. 3. In Tropical Calcific Pancreatitis the calculi are always intra ductal and mostly multiple, dense and large and hence pose great technical difficulties for therapeutic Endoscopic Retrograde Cholangio Pancreatography. 4. Pancreatic stenting is an effective endotherapeutic procedure for the symptomatic relief of pain, improves ductal drainage and quality of life in Tropical Calcific Pancreatitis patients. 5. A new practically useful classification of diagnostic and therapeutic Endoscopic Retrograde Cholangio Pancreatography in Tropical Calcific Pancreatitis have been proposed for easy approach and planning therapy (subash classification). 6. Diagnostic Endoscopic Retrograde Cholangio Pancreatography before therapeutic Endoscopic Retrograde Cholangio Pancreatography provides a learning curve for future therapeutic endoscopists.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Endoscopic Retrograde Cholangio Pancreatography ; Tropical Calcific Pancreatitis. |
| Subjects: | MEDICAL > Gastroenterology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 14 Jul 2017 02:45 |
| Last Modified: | 14 Jul 2017 02:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1599 |
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