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The majority of pancreatic cysts are detected incidentally when abdominal imaging is performed during unrelated procedures. The aim of the present study was to assess the diagnostic utility and clinical value of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and amylase analysis in pancreatic cyst fluid. The study included 52 patients with pancreatic cystic lesions, who underwent fine-needle aspiration biopsy to collect cystic fluid for cytological and biochemical analysis. Cysts were classified as benign (simple cysts, pseudocysts and serous cystadenomas) in 36 patients or premalignant/malignant (mucinous cyst-adenomas, intraductal papillary mucinous neoplasm and cystadenocarcinomas) in 16 patients. CEA and CA 19-9 were elevated in patients with malignant cysts (238±12.5 ng/ml and 222±31.5 U/ml, respectively) compared with benign lesions (34.5±3.7 ng/ml and 18.5±1.9 U/ml, respectively; P<0.001). Based on these results, the sensitivity and specificity of CEA were 91.8 and 63.9% and of CA 19-9 were 81.3 and 69.4%, respectively. Mean amylase levels in benign lesions (27825.7±91.9 U/l) were higher compared with malignant pancreatic cysts (8359.2±32.7 U/l; P<0.05). Cyst fluid analysis may prove a safe and useful adjunct for the differential diagnosis of pancreatic cystic lesions. In the present study, promising results for CEA and CA 19-9 have been demonstrated, however, the clinical value of these molecules must be confirmed.

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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.

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-