[Pancreatic carcinoma on endoscopic retrograde pancreatico-cholangiogram (author's transl)]

The pancreaticographic appearances of carcinoma of the pancreas have been divided into two types: 1. Canalicular carcinoma arising from the duct system. If arising from the main pancreatic duct, it occludes this, or causes displacement or deformity of its branches in the immediate neighbourhood. If arising from branches, it causes cystic ectasia of the minor ducts; these appear fragmented and deformed while there is stenosis and displacement of the main duct. Simultaneous origin from the main and smaller ducts, as in the Gallert carcinoma, causes extreme lacunar ectasia of the minor ducts and occlusion of the main duct. 2. Carcinoma arising from the acinar epithelium. This causes primarily displacement and the secondarily stenosis of the main duct. Accuracy of ERCP is satisfactory. It is limited by technical failure or difficulties due to the pathology preventing demonstration of the pancreatic duct. It is increased by cytological examination of aspirated pancreatic secretion. Difficulties in the differential diagnosis from chronic pancreatitis can be overcome. The possibility of an early diagnosis of the carcinoma presented by this method loses some of its impact because the patients are seen at a late stage and because of the lack of early symptoms of this disease.