Endoscopic retrograde pancreatography in pancreatic trauma: need to break the mental barrier

J Gastroenterol Hepatol. 2009 May;24(5):720-8. doi: 10.1111/j.1440-1746.2009.05809.x. Epub 2009 Mar 12.


Pancreatic injury has a high morbidity and mortality. The integrity of the main pancreatic duct is the most important determinant of prognosis. Serum amylase, peritoneal lavage and computed tomography of the abdomen can assist with diagnosis but endoscopic retrograde pancreatography (ERP) is the most accurate investigation for diagnosing the site and extent of ductal disruption. However, it is invasive and can be associated with significant complications. Magnetic resonance cholangiopancreatography (MRCP) and secretin-enhanced MRCP probably parallel ERP in delineating pancreatic ductal injuries. They can also delineate the duct upstream to complete disruption, an area not visualized on ERP. In relation to therapy, endoscopic transpapillary drainage has been successfully used to heal duct disruptions in the early phase of pancreatic trauma and, in the delayed phase, to treat the complications of pancreatic duct injuries such as pseudocysts and pancreatic fistulae. Transpapillary drainage is especially effective in patients who have partial pancreatic duct disruption that can be bridged. Endoscopic transmural drainage has also been successfully used to treat post-traumatic pancreatic pseudocysts. Further large, prospective and randomized studies are required to adjudge the efficacy and long-term safety of pancreatic duct drainage in the treatment of post-traumatic pancreatic duct injuries.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Amylases
  • Attitude of Health Personnel*
  • Biomarkers / blood
  • Cholangiopancreatography, Endoscopic Retrograde* / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde* / instrumentation
  • Cholangiopancreatography, Endoscopic Retrograde* / psychology
  • Cholangiopancreatography, Magnetic Resonance
  • Clinical Competence
  • Clinical Protocols
  • Drainage
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Pancreatic Ducts / diagnostic imaging*
  • Pancreatic Ducts / injuries
  • Pancreatic Ducts / surgery*
  • Pancreatic Fistula / diagnostic imaging
  • Pancreatic Fistula / surgery
  • Pancreatic Pseudocyst / diagnostic imaging
  • Pancreatic Pseudocyst / surgery
  • Patient Selection
  • Peritoneal Lavage
  • Predictive Value of Tests
  • Stents
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Wounds and Injuries / complications
  • Wounds and Injuries / diagnostic imaging*
  • Wounds and Injuries / surgery*


  • Biomarkers
  • Amylases