内視鏡的膵・胆管造影法の開発とその展開(最終講義)

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  • サイシュウ コウギ ナイシキョウテキ スイ タンカン ゾウエイホウ ノ カイハツ ト ソノ テンカイ
  • Endoscopic Pancreatocholangiography and its Developments

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The world's first endoscopic pancreatocholangiography, now referred to as endoscopic retrograde cholangiopancreatography, was performed on April 15,1969. This purpose of this procedure is to operate on the pancreatic ducts and bile ducts endoscopically through the duodenal papilla. In order to achieve this success over the following obstacles had to be overcome: 1) development of a novel endoscope, 2) insertion of the endoscope into the second portion of the duodenum, 3) identification of the duodenal papilla and cannulation in the correct direction, and 4) production of a catheter. Parallel arrangement of the lens and channel was essential in the design of the endoscope, a feature which is still present in the endoscopes used today. The duodenal papilla was already well recognized from Billroth I gastrectomy studies. The catheter was handmade from a Teflon tube with piano wire inside for stiffness. The procedure for insertion and cannulation has fundamentally not changed. Selective endoscopic pancreatography and cholangiography are now established techniques in clinical use. Almost all pancreatic and biliary diseases including chronic pancreatitis, pancreatic cancer, pancreatic cystic lesions, intraductal papillary mucinous neoplasm, duct anomaly, biliary cancer, biliary stones, and adenomyoma tosis can be analyzed by endoscopic pancreatocholangiography. We investigated the pathogenesis on the basis of pancreatic duct findings to contribute to the clinical criteria of chronic pancreatitis, and to establish the new entities of upstream pancreatitis and autoimmune pancreatitis with narrowing of the main pancreatic duct. Pancreaticobiliary maljunction studied from an embryological point of view has been established to be an important congenital anomaly. Nowadays, endoscopic maneuvers based on endoscopic pancreatocholangiography such as endoscopic sphincterotomy, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, and stenting are essential clinical techniques in the treatment of pancreatic and biliary diseases.

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