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IntroductIon Biliary and pancreatic diseases, especially choledocholithiasis and neoplastic diseases, are commonly seen in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure performed more and more frequently also in elderly patients. objEctIvEs The aim of this study was to evaluate the utility and safety of ERCP in patients >80 years of age. PAtIEnts And mEthods We retrospectively analyzed 821 ERCP performed in the Department of Gastrointestinal Diseases, Medical University of Łódź in the years 2005-2007. We compared age, sex, clinical symptoms, laboratory findings, ERCP efficacy and safety in patients >80 years of age versus younger subjects.

Diagnostic ERCP stimulates a systemic inflammatory response, the intensity of which is magnified after ES. After uncomplicated ERCP, the balance between oxidative and anti-oxidative mechanisms is retained.

Słowa kluczowe: endoskopowa cholangiopankreatografia wsteczna (ECPW), cholangiopankreatografia rezonansu magnetycznego (MRCP), choroby dróg żółciowych, choroby trzustki. Key words: endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), bile duct diseases, pancreatic diseases. StreszczenieWstęp: Złotym standardem w diagnostyce oraz leczeniu chorób trzustki i dróg żółciowych od lat 70. ubiegłego wieku jest endoskopowa cholangiopankreatografia wsteczna (ECPW). Ta metoda inwazyjna obarczona jest jednak licznymi powikła-niami, dlatego trwają poszukiwania nowych technik, które mogłyby służyć diagnostyce dróg żółciowych i trzustkowych. Do takich należy cholangiopankreatografia rezonansu magnetycznego (magnetic resonance cholangiopancreatography -MRCP). Doniesienia na temat skuteczności diagnostycznej MRCP nadal są nieliczne i przynoszą rozbieżne wyniki. Cel: Ustalenie skuteczności, bezpieczeństwa i szczególnych wskazań do MRCP u osób z chorobami trzustki i dróg żółcio-wych. Materiał i metody: Dokonano retrospektywnej analizy 48 historii chorób pacjentów, u których wykonano jednocześnie oba badania -MRCP i ECPW. Wskazaniami do ich przeprowadzenia były objawy kliniczne oraz wyniki badań obrazowych sugerujące patologię dróg żółciowych lub trzustki. Wyniki: Największą czułość i swoistość MRCP (100%) wykazano u chorych ze zwężeniami dróg żółciowych. W chorobach trzustki obserwowano wysoką czułość (100%), ale swoistość nie przekraczała 62,5%. W kamicy przewodowej czułość wynosiła 93,8%, a swoistość 80%. U chorych na pierwotne stwardniające zapalenie dróg żółciowych (primary sclerosing AbstractIntroduction: Endoscopic retrograde cholangiopancreatography (ERCP) is still a gold standard in the diagnostics and treatment of pancreatobiliary diseases. Endoscopic retrograde cholangiopancreatography is also an invasive method with risk of complications. Recently, magnetic resonance cholangiopancreatography (MRCP) has been introduced as a new noninvasive imaging method in detection of pathology in the biliary tract and pancreas. Data on the diagnostic efficacy of MRCP are still rare and incompatible. Aim: To evaluate the clinical efficacy, safety and proper indications of MRCP in pancreatobiliary diseases. Material and methods: We carried out a retrospective analysis of 48 patients in whom ERCP and MRCP were performed. The indications were clinical symptoms and imaging method results which revealed disease in the pancreas or bile ducts. Results: The best efficacy of MRCP was for evaluation of bile duct obstruction. In the present study overall sensitivity and specificity values for detecting lesions in MRCP were in pancreatic diseases 100% and 62.5%, in choledocholithiasis 93.8% and 80%, in primary sclerosing cholangitis (PSC) 50% and 100%, respectively. Magnetic resonance cholangio-pancreatography examination was successfully performed on all patients, whereas ERCP examination was unsuccessful in 6 patients (12.5%), because of technical problems. No compli-

Background: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localization of the major duodenal papilla, duodenal diverticula, and some particular clinical issues. Materials and methods: In total, 628 patients (408 females and 220 males; aged 21-91 years), who underwent ERCP (endoscopic retrograde cholangiopancreatography) were included in this study. The patients were divided into two groups: a study group comprising 66 patients (10.5%) with periampullary position of diverticula (Group A), and a control group comprising 562 patients (89.5%) without diverticula (Group B). Results: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52-91 years) and 25 men (aged 54-83). Conclusions: Three types of localization were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (Type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.