The study protocol was approved by the ethics committee of our institution. ERP followed by pancreatic duct lavage cytology was performed by using a duodenoscope (JF 240 and JF 260V; Olympus, Tokyo, Japan) and an originally designed coaxial double-lumen catheter (5F; Cathex, Tokyo, Japan) (Fig. 2).14 Lavage fluid was collected from the pancreatic duct by using the double-lumen catheter as follows: 1 mL of saline solution was injected through the injection lumen while 1 mL of the

fluid in the pancreatic duct was concomitantly aspirated via the aspiration lumen to avoid an increase AG-014699 concentration in intrapancreatic ductal pressure; as we previously reported, the procedure was carefully repeated until 30 mL of pancreatic duct lavage fluid was obtained.14 After the procedure, the patient was kept under fasting conditions and observed carefully overnight for the appearance of any symptom. If the patient this website was asymptomatic on the next morning and the serum amylase level was below

375 IU/L (normal range <125 IU/L), the patient was permitted to eat a meal. Complications of lavage cytology were defined as any adverse event related to the ERCP during which lavage cytology was performed and that required more than 1 night of hospitalization.15 and 16 Definitions of individual complications were similar to those of Cotton et al.15 Procedure-induced pancreatitis was defined as new or worsened Carnitine palmitoyltransferase II abdominal pain and a amylase serum concentration that was 3 or more times the upper limit of normal at 24 hours after the procedure requiring hospitalization or prolongation of planned admission.15 Severity of pancreatitis was graded according to the length of hospitalization. Mild pancreatitis required 2 to 3 days of hospitalization, moderate pancreatitis required 4 to 10 days of hospitalization, and severe pancreatitis required more than 10 days of hospitalization.15 and 16 Samples of pancreatic duct lavage fluid were transferred

to a test tube and centrifuged at 2000 rpm for 20 minutes. The pellet obtained was transferred onto absorbent paper and fixed in a 10% formaldehyde solution for 24 hours. After that, the material was sequentially subjected to dehydration, clearing, and impregnation by and embedding in paraffin. Sections 5 μm thick were obtained and stained with H&E as well as with MUCs 1, 2, 5AC, and 6. The monoclonal antibodies used were Ma695 (Novocastra, Newcastle, UK) against MUC1, Ccp58 (Novocastra) against MUC2, CLH2 (Novocastra) against MUC5AC, and CLH5 (Novocastra, Newcastle, UK) against MUC6. Two experienced pathologists examined the specimens, both cytologically and histologically, and established the final diagnosis by consensus. The cell block sections stained with hematoxylin and eosin were classified into classes I to V according to the grade of structural and cytological dysplasia.

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