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Dilated pancreatic duct: What to do?
Pancreatic Cancer | Last Active: Aug 4, 2023 | Replies (13)Comment receiving replies
I went to the ER at the end of April due to abdominal pain. It turned out to be enteritis, but the CT scan showed that I had a dilated pancreas at 4.5 mm. The doctor felt that was the most important thing to get evaluated. I made an appointment with a new G.I. doctor, and brought old CT records. I noticed that the first time my pancreas showed dilation was Jan 2023 at 4mm and 4.5mm in April 2023. He decided based on my past history of smoking, which made me high risk, that I should have a EGD/endoscopic ultrasound and biopsy. I had that done a few days ago and it turned out that it was in fact dilated a bit more than the CT showed. The exact description notated by the doctor was, “Focal ductal dilation was noted in the main pancreatic duct in the head of pancreas, measured at 5 mm.” However he didn’t do a biopsy but biopsied my esophagus, stomach and duodenum. I was surprised by that and when I asked why he didn’t do it he said it looked ok to him but it was dilated and needs monitoring. That it was too risky to biopsy and to get an MRI/MRCP in a year. I asked why he did the other biopsies since he told me those areas were normal. He said because of your symptoms and there was no risk to biopsy them even though they were normal. I feel completely uncomfortable and misled. I am thinking I should get a second opinion. I’ve already had to go to Mayo once before for a major misdiagnosis with something else. Thoughts? Anyone have a similar experience? Thanks in advance.
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I, myself, had pain on and off for quite a long time several years after gallbladder surgery. My gastro dr. ordered an MRCP which essentially is an MRI of the pancreas and biliary ductwork. This test is not invasive nor is it dangerous. The ERCP, however, which is a definitive test to treat problems of the bile and biliary ducts pancreas, entails introducting a catheter into the ductwork itself using a contrast dye for imaging under fluoroscopy to look for narrowed areas or blockages which also allows for biopsies, stone removal, tumor removal, etc. This latter procedure can end up possibly causing perforations and infections, and possible excessive bleeding. Notabl, it can also cause pancreatitis which can be life threatening. From what I have read, not all regular gastro drs. do ERCPs since they appear to realize how dangerous they may be if not performed properly.
Thank you for your feedback. I got into a GI doc at Mayo in Jacksonville for next week. She specializes in the pancreas. My biopsy results for the stomach, duodenum and esophagus are not back yet but his initial comments after EGD/EU is that it all looked normal except for redness in the stomach and dilation of the pancreas. I just want a good diagnosis I can trust and proper folllow up. From what I’ve read the dilation of the pancreas must be monitored.
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@lcastaneda
Welcome to Mayo Connect!
I can see why you are confused as to why biopsy was not done of the pancreatic duct and normal results in esophagus stomach and duodenum.
The upper endoscopy was most likely due to certain symptoms you had and to rule out cancer in those areas. Same happened to me this year- I had certain symptoms that pointed towards stomach cancer. My biopsies were also normal. It’s good news that yours are normal too.
It is quite risky to biopsy the pancreatic duct.
They do monitor the pancreatic and common bile duct with MRCP- a special MRI of the ducts. I have had that a couple of times. I also had ERCP after the MRI to treat my bile duct opening. The bile duct and pancreatic duct open together into the duodenum.
We always recommend members get a second opinions- and third- if you are not comfortable with the outcome of a specialist encounter- preferably at a large university hospital or Mayo Clinic for example.