The purpose of this study is to examine the clinical usefulness and the problems of endoscopic approach to pancreatic diseases by sheath method. The subjects are 139 cases with pancreatic diseases (31 cancer, 2 metastatic cancer, 55 chronic pancreatitis, 42 mucin-producing tumor, 4 islet cell tumor, 2 serous cyst adenoma, 1 teratoma, 1 solid cystic turnor, 1 fatty change) for intraductal exarnination (intraductal ultrasonography, peroral pancreatoscopy and pancreatic biopsy) and in 5 cases with pancreatolithiasis for intraductal treatment. We examined the clinical usefulness and problems of the sheath method in comparison with the non-sheath method. This sheath methed is useful for the improvement of the endurance of these instruments, the decrease of the number of times of examination, the shortening of examination time and the effect of washing out the pancreatic duct in the treatment of the pancreatolithiasis through pancreatoscopy. The problems of this method are that speciments obtainedby the pancreatic biopsy are small for the diagnosis (of the pancreatic diseases) and thatit is difficult to insert the instruments into the pancreatic duct when the sheath is ben tduring the examination and the treatment. The acute pancreatitis as one complication is seen in 2 of 117 cases of sheath method (1.7%), one of 22 cases of non-sheath method (4.5%) in the examinations and no camplicataon in the treatment of pancreatelithiasis. In conclusion, the sheath method could allow us the intraductal examinations andtreatment of the pancreatic diseases more easily.
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