Endoscopic Pancreatocholangiography: I. The normal endoscopic pancreatocholangiogram

Endoscopic pancreatocholangiography was successfully performed in 61.5% of 174 attempted cases (83.3% of the most recent 108 attempts). The normal pancreatic duct has a variable configuration, and injection of a progressively increasing volume of contrast material results in opacification of duct branches (primary, secondary, and tertiary), fine pancreatic ducts, and, finally, the acini. Greater degrees of opacification are associated with a higher incidence of amylasemia, but not overt clinical pancreatitis. In 32.4% of cases, a separate opening of the duct of Santorini into the duodenum was found. The pancreatic and common bile ducts terminated in a common channel in 11 of 12 cases where both ducts were visualized. The gallbladder was opacified in 30 of 38 endoscopic cholangiograms. Pancreatography and cholangiography performed through a fiberoptic endoscope are safe and practical diagnostic techniques.