FREQUENCY AND ETIOLOGIC SPECTRUM OF PANCREATIC DUCTAL OBSTRUCTION BASED ON MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT TERTIARY CARE HOSPITALS, PESHAWAR

Background: Pancreatic duct obstruction is an important clinical condition with several causes such as pancreatitis, calculi, pancreatic divisum, malignancy and choledocholithiasis. The clinical presentation varies from abdominal pain, jaundice, nausea, and is not specific, making clinical diagnosis difficult. The introduction of magnetic resonance cholangiopancreatography (MRCP) has made it a preferred technique to ERCP for imaging of the pancreatic ductal system without exposing the patient to ionizing radiation and the risks inherent in ERCP. MRCP can characterize obstruction location, type and degree of dilatation of the obstructed ducts. Objectives: To determine the frequency and etiological spectrum of pancreatic duct obstruction among patients examined with MRCP. Materials and Methods: A retrospective cross-sectional study of MRCP findings in 385 cases of pancreatic ductal obstruction was conducted in Rehman Medical Institute (RMI) and Lady Reading Hospital (LRH). Data concerning patient demographics, presenting symptoms, level and nature of obstruction, as well as etiology were recorded. Statistical analysis involved Chi-square tests to establish associations, and Bayesian estimates of pancreatic duct diameter depending on etiology. Results: Out of 385 patients, 209 (54.3%) were male and 176 (45.7%) were female. Most often, pancreatic duct obstruction occurred in the head of the pancreas (43.6%) followed by the body (37.7%). Epigastric pain was the most common presenting symptom (23.1%), then followed by abdominal pain (19.7%) and previously occurring pain/pancreatitis (19.5%). As for the nature of obstruction, stricture was the most prevalent one (27.3%), followed by pancreatitis (22.9%) and filling defect (20.0%). Calculi (22.3%) and pancreatitis (21.8%) were the leading etiologies, followed by pancreatic mass and periampullary lesions (11.2% each). Pearson Chi-Square test established a significant association between presenting symptoms and etiology of pancreatic duct obstruction (Chi-Square = 102.369, p < 0.001). No significant association was established between the level of obstruction and etiology (p = 0.125) and between gender and etiology (p = 0.146). Bayesian estimate indicated the greatest mean pancreatic duct diameter in choledocholithiasis. Conclusion: MRCP has proved to be an effective tool in elucidating the etiologic spectrum of pancreatic ductal obstruction, with calculi and pancreatitis being the commonest. The significance of the relationship between symptoms and cause underscores the importance of MRCP in diagnosis and management.