日本消化器病学会 アーカイブシステム

セッション情報 International Session3(消化器内視鏡学会・消化器病学会合同)

IgG4-related disease and endoscopy
タイトル 消IS3-1：

Endoscopic findings of the major duodenal papilla of autoimmune pancreatitis.
演者 K.　Chiba（Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital）
共同演者 T.　Kamisawa（Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital）, T.　Tabata（Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital）
抄録 (Aim) Endoscopic and histological findings of the major duodenal papilla of AIP patients were examined.(Methods) Endoscopic findings of the major duodenal papilla regarding swelling, expansion, and redness were prospectively examined in 43 AIP patients. Endoscopic findings were also examined after steroid therapy in 4 patients. We also evaluated the papilla using NBI system in 5 patients. IgG4 immunostaining was performed for biopsy specimens that were taken from the major duodenal papilla in 30 patients.(Results) 1. Abnormal findings (swelling (n=14), expansion (n=3) and redness (n=12)) were observed in 17 (40%) patients. Enlargement of the pancreatic head (100% vs. 69%, p<0.05) and stenosis of the lower bile duct (88% vs. 56%, p<0.05) were more frequent in AIP with abnormal papilla than normal. There were no significant differences in sex ratio, age, serum IgG4 levels, other organ involvement between the two groups. 2. Abundant infiltration of IgG4-positive plasma cells was observed in 12/15 (80%) with abnormal papilla and 3/15 (20%) with normal papilla (p<0.01). 3. On NBI, marked telangiectasia was observed in all 5 patients with abnormal papilla. After steroid therapy, swelling of the papilla improved in all 4 patients but redness remained in 2 patients.(Conclusions) Endoscopic examination including IgG4 immunostaining of biopsy specimens taken from the major duodenal papilla is useful for supporting a diagnosis of AIP with pancreatic head involvement.
索引用語 AIP, papilla