Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis

The Usefulness of Biopsying the Major Duodenal Papilla to Diagnose Autoimmune Pancreatitis: A Prospective Study Using IgG4-Immunostaining

“…In 2002, Unno et al [10] reported that a swollen major duodenal papilla was detected in 41% of 17 patients with AIP, and many infiltrating T lymphocytes were present in the biopsy specimens taken from the swollen papillary tissue. In 2004, www.wjgnet.com Sahin et al [11] reported that dense T-lymphocytic infiltration was present in the resected major duodenal papilla of 2 patients with AIP.…”

Major Duodenal Papilla in Autoimmune Pancreatitis

“…In 2002, Unno et al [9] were the first to report that a swollen major duodenal papilla was a characteristic finding in patients with AIP. In the cited study [9], the authors classified the swelling of the major duodenal papilla by adding the scores of swollen papilla (0–2 points), swollen orad protrusion (0–2 points), indistinct border between the papilla and the orad protrusion (0–1 point), and the presence of telangiectasia (0–1 point).…”

“…In the cited study [9], the authors classified the swelling of the major duodenal papilla by adding the scores of swollen papilla (0–2 points), swollen orad protrusion (0–2 points), indistinct border between the papilla and the orad protrusion (0–1 point), and the presence of telangiectasia (0–1 point). Severe swelling of the major papilla (5–6 points) was observed in 7 (41%) of 17 patients with AIP, whereas none of the patients with other pancreatobiliary diseases [11 with chronic pancreatitis, 13 with primary sclerosing cholangitis, 21 with pancreatic cancer, and 18 with bile duct cancer] had severe swelling of the major papilla [9]. Interestingly, this study [9] showed high inter- and intraobserver agreement (ĸ statistics 0.75–0.95) for a swollen papilla.…”

“…Previous studies suggested that the macroscopic appearance of the major papilla may differentiate AIP from other pancreatobiliary diseases such as malignancies [8,9]. Additional studies revealed that microscopic findings with immunohistochemistry of the major papilla could support the diagnosis of AIP [10,11].…”

IgG4-Related Cardiovascular Disorders

“…5) In 2001, Type 1 AIP with elevated serum IgG4 level and abundant IgG4-positive lymphoplasmacyte infiltration in the pancreas was reported and the concept of IgG4-related disease was proposed. 6) Then, it was gradually discovered that IgG4-related disease involves inflammation and sclerosing in many other organs, 7) especially exocrine organs: 8) bile ducts, 9) lacrimal and salivary glands, 10) retroperitoneum, 11) urinary organs, [12][13][14] pituitary gland, 15) prostate, 16) arteries, [17][18][19][20] veins, [21][22][23] heart, [24][25][26] lung, 25,27,28) eye, 24,29) mesenterium, 30) mammary gland, 31) central nervous system, 32) esophagus, 33) stomach, 34) liver, 35) gastrointestinal tract, 36) thyroid, 37,38) nose, 39) blood, 40,41) skin, 42) and pseudotumors in various organs 9,14,25,[43][44]…”