51
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DeSimone MS, Goodman M, Pehlivanoglu B, Memis B, Balci S, Roa JC, Jang KT, Jang JY, Hong SM, Lee K, Kim H, Choi HJ, Muraki T, Araya JC, Bellolio E, Sarmiento JM, Maithel SK, Losada HF, Basturk O, Reid MD, Koshiol J, Adsay V. T2 gallbladder cancer shows substantial survival variation between continents and this is not due to histopathologic criteria or pathologic sampling differences. Virchows Arch 2021; 478:875-884. [PMID: 33411027 DOI: 10.1007/s00428-020-02968-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Published data on survival of T2 gallbladder carcinoma (GBC) from different countries show a wide range of 5-year survival rates from 30-> 70%. Recently, studies have demonstrated substantial variation between countries in terms of their approach to sampling gallbladders, and furthermore, that pathologists from different continents apply highly variable criteria in determining stage of invasion in this organ. These findings raised the question of whether these variations in pathologic evaluation could account for the vastly different survival rates of T2 GBC reported in the literature. In this study, survival of 316 GBCs from three countries (Chile n = 137, South Korea n = 105, USA n = 74), all adequately sampled (with a minimum of five tumor sections examined) and histopathologically verified as pT2 (after consensus examination by expert pathologists from three continents), was analyzed. Chilean patients had a significantly worse prognosis based on 5-year all-cause mortality (HR: 1.89, 95% CI: 1.27-2.83, p = 0.002) and disease-specific mortality (HR: 2.41, 95% CI: 1.51-3.84, p < 0.001), compared to their South Korean counterparts, even when controlled for age and sex. Comparing the USA to South Korea, the survival differences in all-cause mortality (HR: 1.75, 95% CI: 1.12-2.75, p = 0.015) and disease-specific mortality (HR: 1.94, 95% CI: 1.14-3.31, p = 0.015) were also pronounced. The 3-year disease-specific survival rates in South Korea, the USA, and Chile were 75%, 65%, and 55%, respectively, the 5-year disease-specific survival rates were 60%, 50%, and 50%, respectively, and the overall 5-year survival rates were 55%, 45%, and 35%, respectively. In conclusion, the survival of true T2 GBC in properly classified cases is neither as good nor as bad as previously documented in the literature and shows notable geographic differences even in well-sampled cases with consensus histopathologic criteria. Future studies should focus on other potential reasons including biologic, etiopathogenetic, management-related, populational, or healthcare practice-related factors that may influence the survival differences of T2 GBC in different regions.
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Affiliation(s)
- Mia S DeSimone
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Burcin Pehlivanoglu
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bahar Memis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Serdar Balci
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hye-Jeong Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Takashi Muraki
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Carlos Araya
- Department of Pathology, Hospital Dr. Hernan Henriquez Aravena, Temuco, Chile
| | - Enrique Bellolio
- Department of Pathology, Universidad de La Frontera, Temuco, Chile
| | - Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hector F Losada
- Department of Surgery, Universidad de La Frontera, Temuco, Chile
| | - Olca Basturk
- Department of Pathology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Michelle D Reid
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jill Koshiol
- Division of Cancer Epidemiology & Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute (NCI), NIH, Rockville, MD, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Davutpasa Cad No 4., Topkapi, Istanbul, Turkey.
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Ishizawa T, Kobayashi T, Makino N, Matsuda A, Kakizaki Y, Sugawara S, Ashino K, Takahashi R, Motoi F, Ueno Y. A case of a smooth transition to subsequent percutaneous transjejunal biliary intervention for hepatolithiasis after biliary reconstruction by adding jejunostomy during an emergency operation for perforation due to balloon-assisted endoscopy. Clin J Gastroenterol 2021; 14:678-683. [PMID: 33400187 DOI: 10.1007/s12328-020-01312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/29/2020] [Indexed: 11/09/2022]
Abstract
Treatments for hepatolithiasis include peroral endoscopy, percutaneous cholangioscopy, and surgery. Balloon-assisted endoscopic retrograde cholangiopancreatography (BAERCP) has been widely performed in recent years for patients with hepatolithiasis after biliary reconstruction. However, accidental bowel perforation caused by BAERCP may need emergency surgery. Here, we describe a 77-year-old Japanese woman diagnosed with acute cholangitis due to hepatolithiasis after biliary reconstruction (a biliary diversion operation for pancreaticobiliary maljunction). She underwent BAERCP for treatment of hepatolithiasis, however, a small-bowel perforation occurred. She underwent an emergency operation to suture the perforation and add a catheter jejunostomy. She had no postoperative complications after surgery and was discharged 11 days after surgery. One month later, she was readmitted and underwent percutaneous transjejunal cholangioscopy-guided lithotripsy with complete removal of the calculi. Although endoscopists should be careful to avoid small-bowel perforation during BAERCP, if perforation occurs, addition of a catheter jejunostomy during emergency surgery can be easily transitioned to subsequent treatment of the hepatolithiasis.
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Affiliation(s)
- Tetsuya Ishizawa
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan.
| | - Toshikazu Kobayashi
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Naohiko Makino
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Akiko Matsuda
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Yasuharu Kakizaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Shuichiro Sugawara
- Department of Surgery I, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Koki Ashino
- Department of Surgery I, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Ryosuke Takahashi
- Department of Surgery I, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Fuyuhiko Motoi
- Department of Surgery I, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2, Iidanishi, Yamagata-shi, Yamagata, 990-8595, Japan
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Muraki T, Reid MD, Pehlivanoglu B, Gonzalez RS, Sekhar A, Memis B, Xue Y, Cheng J, Jang KT, Mittal P, Cardona K, Kooby DA, Maithel S, Sarmiento JM, El-Rayes B, Lomberk G, Urrutia RA, Christians K, Tsai S, Evans DB, Adsay V. Variant anatomy of the biliary system as a cause of pancreatic and peri-ampullary cancers. HPB (Oxford) 2020; 22:1675-1685. [PMID: 32336556 DOI: 10.1016/j.hpb.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/01/2020] [Accepted: 03/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cause of most pancreatic and periampullary cancers (PAC) is unknown. Recently, anatomic variations such as pancreatobiliary maljunction have been recognized as risk factors, similar to Barrett-related gastro-esophageal cancers. METHODS Pre-operative MRI from 860 pancreatic/biliary resections, including 322 PACs, were evaluated for low-union (cystic duct joining the common hepatic duct inside of the pancreas or within 5 mm of the pancreatic border) RESULTS: Low-union, seen <10% of the population, was present in 44% of PACs (73% distal bile duct/cholangiocarcinoma, 42% pancreatic head, and 34% ampullary). It was significantly lower(11%) in conditions without connection to the ductal system (thus not exposed to the ductal/biliary tract contents), namely mucinous cystic neoplasms and intrahepatic cholangiocarcinomas(p < 0.0001). Intra-pancreatic type low-union was seen in 16% of PACs versus 2% of controls(p < 0.0001). DISCUSSION This study establishes an association between low-union and PACs, and points to an anatomy-induced chemical/bilious carcinogenesis. This may explain why most pancreas cancers are in the head. It is possible that the same chemical milieu, caused by conditions other than low-union/insertion, may also play a role in the remaining half of PACs. This opens various treatment opportunities including milieu modifications (chemoprevention), focused screening of at-risk patients, and early detection with possible corrective actions.
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Affiliation(s)
- Takashi Muraki
- Department of Pathology, Emory University School of Medicine, GA, USA
| | - Michelle D Reid
- Department of Pathology, Emory University School of Medicine, GA, USA
| | | | - Raul S Gonzalez
- Department of Pathology, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aarti Sekhar
- Department of Radiology, Emory University School of Medicine, GA, USA
| | - Bahar Memis
- Department of Pathology, Emory University School of Medicine, GA, USA
| | - Yue Xue
- Department of Pathology, Emory University School of Medicine, GA, USA
| | - Jeanette Cheng
- Department of Pathology, Piedmont Hospital, Atlanta, GA, USA
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Seoul, South Korea
| | - Pardeep Mittal
- Department of Radiology, Emory University School of Medicine, GA, USA
| | - Kenneth Cardona
- Department of Surgery, Emory University School of Medicine, GA, USA
| | - David A Kooby
- Department of Surgery, Emory University School of Medicine, GA, USA
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, GA, USA
| | - Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, GA, USA
| | - Bassel El-Rayes
- Department of Medical Oncology, Emory University School of Medicine, GA, USA
| | - Gwen Lomberk
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Raul A Urrutia
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey; Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.
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Iwasaki T, Otsuka Y, Miyata Y, Einama T, Tsujimoto H, Ueno H, Ogata S, Kishi Y. Intracholecystic papillary neoplasm arising in a patient with pancreaticobiliary maljunction: a case report. World J Surg Oncol 2020; 18:292. [PMID: 33168026 PMCID: PMC7654008 DOI: 10.1186/s12957-020-02072-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumorigenesis of ICPNs remains unclear. Case presentation A 52-year-old Japanese woman was referred for the assessment of dilation of the bile duct. Computed tomography which revealed an enhanced mass in the gallbladder and endoscopic retrograde cholangiopancreatography confirmed that the confluence of the main pancreatic duct and extrahepatic bile duct (EHBD) was located outside the duodenal wall. Under the diagnosis of gallbladder cancer with PBM, cholecystectomy with full thickness dissection, EHBD resection, lymph node dissection, and hepaticojejunostomy were performed. Macroscopic examination of the resected specimen showed that the cystic duct was dilated and joined into the EHBD just above its confluence with the pancreatic duct, and the inflamed change of non-tumorous mucosa of gallbladder indicating that there was considerable mucosal injury due to pancreatobiliary reflux to the gallbladder. Histopathological examination revealed that the gallbladder tumor was a gastric-type ICPN with non-invasive component. Either KRAS gene mutation or p53 protein expression that were known to be associated with the carcinogenesis of biliary cancer under the condition of pancreatobiliary reflux was not detected in the tumor cells of ICPN. Conclusion The present case might suggest that there was no association between PBM and ICPN. To reveal the tumorigenesis of ICPN and its attribution to pancreatobiliary reflux, however, further study is warranted.
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Affiliation(s)
- Toshimitsu Iwasaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Yasuhiro Otsuka
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoichi Miyata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takahiro Einama
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Sho Ogata
- Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Italian Clinical Practice Guidelines on Cholangiocarcinoma - Part I: Classification, diagnosis and staging. Dig Liver Dis 2020; 52:1282-1293. [PMID: 32893173 DOI: 10.1016/j.dld.2020.06.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
Cholangiocarcinoma (CCA) is the second most common primary liver cancer, characterized by a poor prognosis and resistance to chemotherapeutics. The progressive increase in CCA incidence and mortality registered worldwide in the last two decades and the need to clarify various aspects of clinical management have prompted the Italian Association for the Study of the Liver (AISF) to commission the drafting of dedicated guidelines in collaboration with a group of Italian scientific societies. These guidelines have been formulated in accordance with the Italian National Institute of Health indications and developed by following the GRADE method and related advancements.
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56
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Guo WL, Wang J. Preoperative one-stop magnetic resonance imaging evaluation of the pancreaticobiliary junction and hepatic arteries in children with pancreaticobiliary maljunction: a prospective cohort study. Surg Today 2020; 51:79-85. [PMID: 32656698 DOI: 10.1007/s00595-020-02077-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Pancreaticobiliary maljunction (PBM) is routinely assessed by intraoperative cholangiography (IOC), whereas accompanying abnormalities in the hepatic artery are assessed by preoperative contrast multi-slice computed tomography (MSCT). We evaluated the efficiency of performing one-stop preoperative magnetic resonance imaging (MRI) for delineating the anatomy of the pancreaticobiliary junction and the hepatic artery. METHODS The subjects of this prospective analysis were children who underwent Roux-en-Y surgery for PBM in our institution during a recent 3-year period. Preoperative one-stop MRI was conducted using 3.0-T MRI. The efficiency of one-stop MRI was compared with that of IOC for assessing the bile duct, and with contrast MSCT for assessing the blood vessels. RESULTS Sixty-five children underwent one-stop preoperative MRI, which had a 100% concordance rate, versus IOC for assessing the bile duct type. Protein plugs or cholelithiasis were identified by IOC in 8 children and by one-stop MRI in 45 children (P = 0.0233). Cholangitis was not identified by IOC in any children but it was identified by one-stop MRI in 29 children. MSCT was also performed in 46 children and revealed a variant hepatic artery in 9 and cholangitis in 21. One-stop MRI had a 100% concordance rate versus MSCT. CONCLUSION Preoperative one-stop MRI accurately delineates the bile duct anatomy as well as the hepatic artery, cholangitis, and protein plugs in children with PBM.
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Affiliation(s)
- Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Jian Wang
- Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China.
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Ariake K, Unno M, Yoshida H, Kubo S, Horiguchi A, Yamaue H, Yamamoto M. Risk factors and characteristics of young patients with the biliary tract carcinoma: results of a project study for biliary surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:571-580. [PMID: 32510820 PMCID: PMC7540267 DOI: 10.1002/jhbp.776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to elucidate the characteristics of biliary tract carcinoma (BTC) in young patients. METHODS This is a nationwide multicenter, retrospective cohort study supervised by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS). Clinicopathological data of patients aged <50 years diagnosed with BTC from January 1997 to December 2011 were collected from 211 training institutes for highly advanced surgery registered by the JHBPS. RESULTS Data of 774 young patients aged <50 years were obtained from 102 institutes. Pancreaticobiliary maljunction (PBM) (10.6%) was most frequently associated with young BTC. However, organic solvents caused by printing or other occupations were only 2.5%. PBM was further associated with early onset of BTC and was noted in 38.9% of patients aged <30 years. Subgroup analysis revealed that the distributions of PBM, choledochal cysts, cholelithiasis, hepatitis B virus, and past history of cancer were significantly varied depending on the site of BTC. These results suggested that each site of BTC has a different mechanism for cancer development. CONCLUSION Although the most frequent factor for young BTC patients was PBM, cancer-associated factors were dramatically different in each BTC site. These results might be useful to elucidate the etiology of young BTC patients.
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Affiliation(s)
- Kyohei Ariake
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Yoshida
- Department of Surgery, Iwaki City Medical Center, Iwaki, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterology, School of Medicine Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Sugita R, Ito K, Noda Y. Value of pancreatic and biliary flow MR imaging in the evaluation of pancreaticobiliary disorders. Jpn J Radiol 2020; 38:507-515. [DOI: 10.1007/s11604-020-00940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/25/2020] [Indexed: 11/24/2022]
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Miyoshi H, Inui K, Katano Y, Tachi Y, Yamamoto S. B-mode ultrasonographic diagnosis in gallbladder wall thickening. J Med Ultrason (2001) 2020; 48:175-186. [PMID: 32333131 DOI: 10.1007/s10396-020-01018-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Diseases associated with gallbladder wall thickening include benign entities such as adenomyomatosis of the gallbladder, acute and chronic cholecystitis, and hyperplasia associated with pancreaticobiliary maljunction, and also cancer. Unique conditions such as sclerosing cholecystitis and cholecystitis associated with immune checkpoint inhibitor treatment can also manifest as wall thickening, as in some systemic inflammatory conditions. Gallbladder cancer, the most serious disease that can show wall thickening, can be difficult to diagnose early and to distinguish from benign causes of wall thickening, contributing to a poor prognosis. Differentiating between xanthogranulomatous cholecystitis and gallbladder cancer with wall thickening can be particularly problematic. Cancers that thicken the wall while coexisting with benign lesions that cause wall thickening represent another potential pitfall. In contrast, some benign gallbladder lesions that can cause wall thickening, such as adenomyomatosis and acute cholecystitis, typically show characteristic ultrasonographic features that, together with clinical findings, permit easier diagnosis. In this review of the literature, we describe B-mode abdominal ultrasonographic diagnosis of gallbladder lesions showing wall thickening.
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Affiliation(s)
- Hironao Miyoshi
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
| | - Kazuo Inui
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshiaki Katano
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Yoshihiko Tachi
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Satoshi Yamamoto
- Department of Gastroenterology, Bantane Hospital, Fujita Health University School of Medicine, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
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Abstract
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join outside the duodenal wall, usually forming a long common channel. A major issue in patients with PBM is the risk of biliary cancer. Because the sphincter of Oddi does not regulate the pancreaticobiliary junction in PBM, pancreatic juice frequently refluxes into the biliary tract and can cause various complications, including biliary cancer. Most cancers arise in the gallbladder or dilated common bile duct, suggesting that bile stasis is related to carcinogenesis. Early diagnosis and prophylactic surgery to reduce the risk of cancer are beneficial. The diagnosis of PBM is made mainly on the basis of imaging findings. The development of diagnostic imaging modalities such as multidetector CT and MR cholangiopancreatography has provided radiologists with an important role in diagnosis of PBM and its complications. Radiologists should be aware of PBM despite the fact that it is rare in non-Asian populations. In this review, the authors present an overview of PBM with emphasis on diagnosis and management of PBM and its complications. For early diagnosis, the presence of extrahepatic bile duct dilatation or gallbladder wall thickening may provide a clue to PBM with or without biliary dilatation, respectively. The pancreaticobiliary anatomy should be closely examined if imaging reveals these findings. Radiologists should also carefully evaluate follow-up images in PBM patients even years after prophylactic surgery because residual bile ducts remain at risk for cancer.©RSNA, 2020.
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Affiliation(s)
- Ayako Ono
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shigeki Arizono
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroyoshi Isoda
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Togashi
- From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Hukkinen M, Björnland K, Gatzinsky V, Iber T, Johansen LS, Qvist N, Stenström P, Svensson JF, Pakarinen MP. Management strategies and treatment results of pediatric choledochal malformations in the Nordic countries. HPB (Oxford) 2020; 22:161-168. [PMID: 31371244 DOI: 10.1016/j.hpb.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/28/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Incidence and long-term outcomes of choledochal malformations (CMs) in children remain unclear. METHODS Clinical characteristics, operative details, complications, and follow-up data were collected from eight pediatric surgical centers in Sweden, Norway, Denmark, and Finland, which also answered a questionnaire addressing management practices. RESULTS During 2000-2017, 126 pediatric CMs were diagnosed, corresponding an incidence of 1:37,400. Diagnostic, treatment, and follow-up practices varied markedly. Of patients with complete clinical data (n = 119), 85% and 11% had type I and IV CMs and were managed by open hepaticojejunostomy at median age of 2.5 (interquartile range 0.46-5.8) years. Associated malformations were more common in fusiform and type IV (23%) than cystic CMs (8%, p = 0.043). Pancreaticobiliary maljunction was more frequently confirmed in patients presenting with pancreatitis (26% vs. 7%, p = 0.005) and with fusiform CMs (56% vs. 25%, p = 0.001). Cholangitis/pancreatitis episodes, occurring in 12% during postoperative follow-up of 4.0 (2.0-7.9) years, associated with longer surveillance (OR 1.32, 95% CI 1.13-1.54, p < 0.001). However, only two thirds of centers continued follow-up until adulthood. No malignancies were reported. CONCLUSIONS CM incidence was higher than traditionally reported among Western populations. Although open hepaticojejunostomy carries good short-term outcomes, long-term morbidity is noteworthy. Standardized evidence-based management strategies and long-term follow-up are encouraged.
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Affiliation(s)
- Maria Hukkinen
- Pediatric Liver and Gut Research Group and Section of Pediatric Surgery, Helsinki University Children's Hospital, Helsinki, Finland
| | - Kristin Björnland
- Section of Pediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Vladimir Gatzinsky
- Section of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Tarja Iber
- Section of Pediatric Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Niels Qvist
- Surgical Department A, Odense University Hospital, Odense, Denmark
| | - Pernilla Stenström
- Section of Pediatric Surgery, Skåne University Hospital, Lund University
| | - Jan F Svensson
- Section of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Mikko P Pakarinen
- Pediatric Liver and Gut Research Group and Section of Pediatric Surgery, Helsinki University Children's Hospital, Helsinki, Finland.
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Ataka R, Ito T, Masui T, Seo S, Ishii T, Ogiso S, Yagi S, Taura K, Uemoto S. Cholangiocarcinoma after flow diversion surgery for congenital biliary dilatation: A case report and review of literature. World J Hepatol 2019; 11:743-751. [PMID: 31772721 PMCID: PMC6856020 DOI: 10.4254/wjh.v11.i11.743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/19/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreaticobiliary maljunction (PBM) can be classified into two categories, PBM with congenital biliary dilatation (CBD) or PBM without biliary dilatation, and the management of PBM is often controversial. The treatment for PBM with CBD is prophylactic flow diversion surgery, and some authors have reported that the incidence of cancer after extrahepatic bile duct excision is less than 1%. A very rare case of intrahepatic cholangiocarcinoma 6 years after flow diversion surgery for PBM with CBD is reported.
CASE SUMMARY A 30-year-old man was diagnosed as having PBM with CBD, Todani classification type IVA, because of abnormal liver enzyme profiles. He underwent flow diversion surgery and cholecystectomy, and the specimen showed adenocarcinoma foci, pT1, pStage IA. Five and a half years passed without any recurrence of bile duct cancer. However, 6 years after his operation, computed tomography showed a gradually growing nodule in the bile duct. Fluorodeoxyglucose positron emission tomography showed high uptake, and magnetic resonance imaging showed restricted diffusion signals. On double balloon enteroscopy, the nodule at the posterior bile duct-jejunum anastomosis was directly visualized, and its biopsy specimen showed adenocarcinoma. The patient underwent right lobectomy and biliary reconstruction. The pathological diagnosis was intraductal papillary neoplasm with high-grade intraepithelial neoplasia, pTis, pN0, pStage 0. The patient’s postoperative course was uneventful, and he has had no recurrence up to the present time.
CONCLUSION This case suggests the necessity of careful observation after flow diversion surgery, especially when PBM with CBD is detected in adulthood.
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Affiliation(s)
- Ryo Ataka
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takashi Ito
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Toshihiko Masui
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Satoru Seo
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takamichi Ishii
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Satoshi Ogiso
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Kojiro Taura
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shinji Uemoto
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Yoshimoto K, Kamisawa T, Kikuyama M, Kuruma S, Chiba K, Igarashi Y. Classification of pancreaticobiliary maljunction and its clinical features in adults. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:541-547. [PMID: 31633314 DOI: 10.1002/jhbp.691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In pancreaticobiliary maljunction (PBM), reflux of pancreatic juice and bile produces various pathological conditions in the biliary tract and pancreas. Clinical features according to the classification of PBM by confluence between the distal bile duct and the main pancreatic duct proposed in 2015 were evaluated in children. METHODS Clinical features and complicating diseases according to the PBM classification were evaluated in 168 adult PBM patients. Patency of Santorini duct and associated biliary carcinomas were evaluated in 123 patients. RESULTS Similar to children, there were significant differences in age (P < 0.01) and type of common bile duct (P < 0.01) between the groups of the classification. Unlike in children, there was no significant difference in the incidence of abdominal pain and hyperamylasemia. There were 87 associated biliary carcinomas (79 gallbladder carcinomas and eight cholangiocarcinomas). PBM patients with a cudgel-type Santorini duct, which is greater than 2 mm in diameter, did not develop biliary carcinomas, compared to 61.1% of those with other types of Santorini duct (P < 0.01). CONCLUSIONS Clinical features according to the PBM classification in adults were different from those in children. Although biliary carcinomas were frequently seen in adult PBM patients, none of those with a cudgel-type Santorini duct developed biliary carcinoma.
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Affiliation(s)
- Kensuke Yoshimoto
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
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A Naming Confusion About Biliary Dilatation. J Clin Gastroenterol 2019; 53:779. [PMID: 31513028 DOI: 10.1097/mcg.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Guo WL, Geng J, Zhao JG, Fang F, Huang SG, Wang J. Gene expression profiling reveals upregulated FUT1 and MYBPC1 in children with pancreaticobiliary maljunction. Braz J Med Biol Res 2019; 52:e8522. [PMID: 31365696 PMCID: PMC6668958 DOI: 10.1590/1414-431x20198522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023] Open
Abstract
Pancreaticobiliary maljunction (PBM) is associated with high risk of epithelial atypical growth and malignant transformation of the bile duct or gallbladder. However, overall changes in genetic expression have not been examined in children with PBM. Genome-wide expression was analyzed using peripheral blood samples from 10 children with PBM and 15 pediatric controls. Differentially expressed genes (DEGs) were identified using microarray. Bioinformatics analysis was conducted using Gene Ontology and KEGG analyses. The top 5 in the up-regulated genes in PBM were verified with qRT-PCR. Receiver operator characteristic curve analysis was conducted to evaluate the predictive accuracy of selected genes for PBM. The microarray experiments identified a total of 876 DEGs in PBM, among which 530 were up-regulated and the remaining 346 were down-regulated. Verification of the top 5 up-regulated genes (TYMS, MYBPC1, FUT1, XAGE2, and GREB1L) by qRT-PCR confirmed the up-regulation of MYBPC1 and FUT1. Receiver operating characteristic curve analysis suggested that FUT1 and MYBPC1 up-regulation could be used to predict PBM, with the area under the curve of 0.873 (95%CI=0.735-1.000) and 0.960 (95%CI=0.891-1.000), respectively. FUT1 and MYBPC1 were up-regulated in children with PBM, and could be used as potential biomarkers for PBM.
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Affiliation(s)
- Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China
| | - Jia Geng
- Clinical Laboratory, the 3rd Hospital of Yulin, Yulin, China
| | - Jun-gang Zhao
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Fang Fang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Shun-Gen Huang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China
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Garzón Benavides M, Núñez Ortiz A, López Ruiz T, Cepeda Franco C, Gómez Izquierdo L. Pancreatobiliary maljunction: association with gallbladder cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:568-570. [PMID: 31215211 DOI: 10.17235/reed.2019.6127/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pancreatobiliary maljunction is a rare disease characterized by the junction of the pancreatic and biliary ducts outside of the duodenal wall, which normally results in a large common duct. As a result, there is a greater risk of acute pancreatitis and cancer of the gallbladder and biliary tract. CASE REPORT We present the case of a 43-year-old female diagnosed with a pancreatobiliary maljunction and an associated stenosis of the bile duct, secondary to an episode of acute pancreatitis. She underwent several endoscopic retrograde cholangiopancreatography procedures over the course of three years, without improvement of the stenosis, and therefore a surgical approach was taken. Prior to the surgical intervention, magnetic resonance imaging showed the presence of an 11-mm polyp in the gallbladder. A histological study of the surgical sample identified intramucosal adenocarcinoma over a tubular adenoma of the gallbladder. DISCUSSION Pancreatobiliary maljunction can be considered as a premalignant entity due to the risk of developing cancer of the biliary tree and gallbladder. Therefore, these patients should undergo a prophylactic intervention, despite being asymptomatic.
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Affiliation(s)
- Marta Garzón Benavides
- Department of Gastroenterology. Hospital Virgen, Hospital Universitario Virgen del Rocío, Spain
| | - Andrea Núñez Ortiz
- U.G.C Aparato Digestivo, Hospital Universitario Virgen del Rocío, España
| | - Teófilo López Ruiz
- Department of Gastroenterology. Endoscopy Secti, Hospital Universitario Virgen del Rocío
| | - Carmen Cepeda Franco
- Department of Hepatobiliary-Pancreatic Surgery., Hospital Universitario Virgen del Rocío
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Laparoscopic approach for choledochojejunostomy. Hepatobiliary Pancreat Dis Int 2019; 18:285-288. [PMID: 31023579 DOI: 10.1016/j.hbpd.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023]
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68
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Abstract
According to GLOBOCAN 2018 data, gallbladder cancer (GBC) accounts for 1.2% of all global cancer diagnoses, but 1.7% of all cancer deaths. Only 1 in 5 GBC cases in the United States is diagnosed at an early stage, and median survival for advanced stage cancer is no more than about a year. The incidence of the disease is increasing in the developed world. Gallstones, biliary cysts, carcinogen exposure, typhoid, and Helicobacter pylori infection, and abnormal pancreaticobiliary duct junctions are all risk factors, many of which account for its geographical, ethnic and sex distribution. Genetics also plays a strong role, as about a quarter of GBC cases are considered familial, and certain ethnicities, such as Native Americans, are at far higher risk for the neoplasm. Prevention includes weight loss, vaccination against and treatment of bacterial infections, early detection and elimination of polyps and cysts, and avoidance of oral estrogen replacement therapy.
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69
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Matsushita M, Koyabu M, Nishio A, Seki T, Okazaki K. Management of anomalous pancreaticobiliary junction. Gastrointest Endosc 2019; 89:898. [PMID: 30902213 DOI: 10.1016/j.gie.2018.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Masanori Koyabu
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Akiyoshi Nishio
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Toshihito Seki
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuichi Okazaki
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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Sato N, Shimura T, Kenjo A, Kimura T, Watanabe J, Muto M, Marubashi S. Pancreaticobiliary maljunction diagnosed long after laparotomy in the neonatal period for annular pancreas: report of a case. Surg Case Rep 2019; 5:16. [PMID: 30707318 PMCID: PMC6361191 DOI: 10.1186/s40792-019-0572-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although annular pancreas concurrent with pancreaticobiliary maljunction has rarely been reported, some reports have pointed out a possibility that both anomalies have a common pathogenesis in pancreatic development. We herein report a case with pancreaticobiliary maljunction diagnosed long after surgical treatment for annular pancreas. CASE PRESENTATION A 34-year-old female, with a surgical history of duodenal obstruction due to annular pancreas in the neonatal period, was referred to our hospital for further examination of chronic pancreatitis. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed choledocholithiasis, pancreatic lithiasis, and pancreaticobiliary maljunction without biliary dilatation. Choledocholithotomy and cholecystectomy were performed, and highly elevated levels of amylase in bile from the common bile duct were found intraoperatively. CONCLUSION The present case highlights a possible association of pancreaticobiliary maljunction in a patient with annular pancreas.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Tatsuo Shimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Junichiro Watanabe
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Makoto Muto
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295 Japan
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Hyvärinen I, Hukkinen M, Kivisaari R, Parviainen H, Nordin A, Pakarinen MP. Increased prevalence of pancreaticobiliary maljunction in biliary malignancies. Scand J Surg 2019; 108:285-290. [PMID: 30630392 DOI: 10.1177/1457496918822617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM The incidence of pancreaticobiliary maljunction is thought to approximate 1:100,000 within Western populations. We aimed to study the significance of pancreaticobiliary maljunction in biliary tract malignancies. METHODS Medical records and magnetic resonance cholangiopancreatography images of 252 consecutive patients treated for biliary malignancies during 2005-2016 were reviewed. Patients with other known risk factors for biliary cancers (n = 27) were excluded. A common pancreaticobiliary channel measuring ⩾10 mm outside the duodenal wall was defined as pancreaticobiliary maljunction. MAIN RESULTS Of the 225 patients, a reliably interpretable preoperative magnetic resonance cholangiopancreatography was available for 73 (32%). Sex (47% vs 57% females) and age at diagnosis (67 vs 66 years) were similar among patients with or without an magnetic resonance cholangiopancreatography (p = ns for both). In magnetic resonance cholangiopancreatography, a pancreaticobiliary maljunction with a median length of 20 mm (range 10-23 mm) was identified in four patients (5.5%, 95% confidence interval 1.6-14), while none had evident accompanying biliary tree dilatation. Pancreaticobiliary maljunction patients were significantly more often females (100% vs 43%, p = 0.043), less likely to have intrahepatic bile duct cancer (0% vs 65%, p = 0.019) while more likely to have gallbladder cancer (75% vs 22%, p = 0.044) compared to the others. Age at diagnosis (66 vs 67 years, p = 0.898), extrahepatic bile duct cancer incidence (25% vs 13%, p = 0.453), and survival status at last follow-up (50% vs 42% alive, p = 1.000) were comparable between the subgroups. CONCLUSION The prevalence of pancreaticobiliary maljunction is substantially higher in adults with biliary malignancies than one would expect based on its incidence, reinforcing the etiologic role of pancreaticobiliary maljunction especially in females with gallbladder cancer.
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Affiliation(s)
- I Hyvärinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - M Hukkinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - R Kivisaari
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Parviainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Nordin
- Liver and Transplantation Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - M P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki, Helsinki, Finland
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Khan TT, Ahmad N. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts. World J Surg 2018; 42:3817-3818. [PMID: 29288314 DOI: 10.1007/s00268-017-4455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Nadeem Ahmad
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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The Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients With Acute Pancreatitis After Negative Computed Tomography Findings of the Etiology. Pancreas 2018; 47:1165-1171. [PMID: 30142119 DOI: 10.1097/mpa.0000000000001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed to investigate the roles of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in detecting the causes of acute pancreatitis after negative computed tomography (CT) findings. METHODS Demographic characteristics, blood test results, the severity of pancreatitis, and definite or possible etiology of pancreatitis by EUS and MRCP were evaluated prospectively in 65 consecutively admitted patients after negative CT findings. RESULTS Endoscopic ultrasonography and/or MRCP confirmed the definite causes of pancreatitis in 47.7% (31/65) (choledocholithiasis, 25; pancreatic divisum, 3; pancreatic cancer, 1; and pancreatic intraductal papillary mucinous neoplasm, 1). The possible causes were cholelithiasis in 75.4%, pancreaticobiliary common channel (PBCC) in 70.8%, and both in 89.2%. The diagnostic values of EUS were higher than MRCP for choledocholithiasis (35.4% vs 12.3%, P < 0.05). Cholelithiasis and the common bile duct diameter were independent factors for the definite etiology of acute pancreatitis. Choledocholithiasis was inversely associated with PBCC, and the common bile duct diameter was the only independent factor associated with PBCC. CONCLUSIONS Endoscopic ultrasonography is a useful imaging modality for detecting definite or possible causes of acute pancreatitis. A PBCC as well as biliary lithiasis could be not uncommon causes of acute pancreatitis after negative CT findings.
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Kamisawa T, Kaneko K, Itoi T, Ando H. Pancreaticobiliary maljunction and congenital biliary dilatation. Lancet Gastroenterol Hepatol 2018; 2:610-618. [PMID: 28691687 DOI: 10.1016/s2468-1253(17)30002-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
Pancreaticobiliary maljunction is a congenital malformation in which the pancreatic and bile ducts join outside the duodenal wall, usually forming a long common channel. Because the action of the sphincter of Oddi does not regulate the function of the pancreaticobiliary junction in patients with pancreaticobiliary maljunction, two-way regurgitation occurs. Reflux of pancreatic juice into the biliary tract is associated with a high incidence of biliary cancer. Biliary carcinogenesis in patients with pancreaticobiliary maljunction is thought to follow the hyperplasia, dysplasia, then carcinoma sequence due to chronic inflammation caused by pancreatobiliary reflux. Pancreaticobiliary maljunction is diagnosed when an abnormally long common channel is evident on imaging studies. Congenital biliary dilatation involves both local dilatation of the extrahepatic bile duct, including the common bile duct, and pancreaticobiliary maljunction. Extrahepatic bile duct resection is the standard surgery for congenital biliary dilatation. However, complete excision of the intrapancreatic bile duct and removal of stenoses of the hepatic ducts are necessary to prevent serious complications after surgery.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | - Kenitiro Kaneko
- Division of Pediatric Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hisami Ando
- Department of Pediatric Surgery, Aichi Prefectural Colony, Kasugai, Japan
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Embryological etiology of pancreaticobiliary system predicted from pancreaticobiliary maljunction with incomplete pancreatic divisum: a case report. BMC Surg 2018; 18:50. [PMID: 30068344 PMCID: PMC6090945 DOI: 10.1186/s12893-018-0385-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The genesis of the "complex type" classification of pancreaticobiliary maljunction (PBM) is unclear, and the pancreaticobiliary anatomy is also varied according to each case. We encountered a patient with PBM and incomplete pancreatic divisum (PD). We herein discussed about the embryological etiology of pancreaticobiliary system predicted from PBM with incomplete PD. CASE PRESENTATION A 67-year-old man was found to have a dilatation of the common bile duct (CBD) during a medical examination at 62 years of age. The dilatation of the CBD subsequently progressed, and he was admitted to our hospital for surgical treatment. Magnetic resonance cholangiopancreatography revealed a dilatation from the common hepatic duct to the middle bile duct with PBM. Endoscopic retrograde cholangiopancreatography from the papilla of Vater revealed the pancreatic main duct via the pancreatic branch duct, and PBM with dilatation of the CBD and incomplete PD were revealed. We performed an extrahepatic bile duct resection and hepaticojejunostomy because of high risk of malignant transformation. Taping and transection of the bile duct without dilatation on the pancreatic side were performed, and thereafter, two orifices of the common channel and ventral pancreatic duct were ligated. The level of amylase in the bile was 7217 IU/L, and a histological examination of the CBD showed an inflammatory change of CBD, not a malignant transformation. CONCLUSION It is somewhat easy to identify the pancreatobiliary anatomy when the cause of embryology of both PBM and PD is thought to be an abnormal embryology of the ventral pancreas.
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76
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Wang XQ, Xu SJ, Wang Z, Xiao YH, Xu J, Wang ZD, Chen DX. Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review. World J Clin Cases 2018; 6:143-149. [PMID: 30079341 PMCID: PMC6068812 DOI: 10.12998/wjcc.v6.i7.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/23/2018] [Accepted: 04/22/2018] [Indexed: 02/05/2023] Open
Abstract
Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3 (0.3-15.9) years; the male-to-female ratio was 1:3.5 (19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9% (79/86). The average total operation time was 426 (180-520) min, the operation time on the machine was 302 (120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of robotic-assisted choledochocystectomy was 8.8 d. Eight patients had biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons’ experience, robotic surgery may become a new trend in this surgical procedure.
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Affiliation(s)
- Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Shu-Juan Xu
- Center of Anesthesia and Operation, PLA General Hospital, Beijing 100853, China
| | - Zheng Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Yuan-Hong Xiao
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Jing Xu
- Center of Anesthesia and Operation, PLA General Hospital, Beijing 100853, China
| | - Zhen-Dong Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Di-Xiang Chen
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
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Jin Z, Bie LK, Tang YP, Ge L, Shen SS, Xu B, Li T, Gong B. Endoscopic therapy for patients with pancreaticobiliary maljunction: a follow-up study. Oncotarget 2018; 8:44860-44869. [PMID: 28415772 PMCID: PMC5546526 DOI: 10.18632/oncotarget.16228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background Data on the experience of endoscopic retrograde cholangiopancreatography (ERCP) in the management of pancreaticobiliary maljunction (PBM) is limited. Methods A retrospective review of patients with PBM who underwent therapeutic ERCP at our endoscopy center between January 2008 and January 2016 was performed. Demographic, clinical, radiological and endoscopic data was documented. Patients who underwent sphincterotomy were divided into dilated group and undilated group based on their common channel diameter. Results Sixty-three PBM patients underwent 74 ERCP procedures. The technical success rate was 97.3%. ERCP therapy significantly decreased the levels of elevated liver enzymes and bilirubin. After an average of 27 months follow-up, 7 patients (11.1%) were lost. The overall effective rate of ERCP therapy was 60.7% (34/56). Decline in severity and frequency of abdominal pain was significant. Procedure-related complications were observed in 5 (6.8%) cases. Between the dilated group and undilated group, no significant difference was observed in effective rate, adverse events and follow-up results. Conclusions ERCP can serve as a transitional step to stabilize PBM patients before definitive surgery. PBM patients with undilated common channel could benefit from sphincterotomy as well as those with dilated common channel.
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Affiliation(s)
- Zheng Jin
- Department of Gastroenterology, Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,First People's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Li-Ke Bie
- Department of Gastroenterology, Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan-Ping Tang
- First People's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Liang Ge
- Department of Gastroenterology, Shihezi People's Hospital, Shihezi, China
| | - Si-Si Shen
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bin Xu
- Department of Gastroenterology, Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Li
- Department of Gastroenterology, Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biao Gong
- Department of Gastroenterology, Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Matsumoto T, Seno H. Updated Trends in Gallbladder and Other Biliary Tract Cancers Worldwide. Clin Gastroenterol Hepatol 2018; 16:339-340. [PMID: 29174787 DOI: 10.1016/j.cgh.2017.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/11/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Tomonori Matsumoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Aoki Y, Aida J, Kawano Y, Nakamura KI, Izumiyama-Shimomura N, Ishikawa N, Arai T, Nakamura Y, Taniai N, Uchida E, Takubo K, Ishiwata T. Telomere length of gallbladder epithelium is shortened in patients with congenital biliary dilatation: measurement by quantitative fluorescence in situ hybridization. J Gastroenterol 2018; 53:291-301. [PMID: 29143121 DOI: 10.1007/s00535-017-1411-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Congenital biliary dilatation (CBD) is a congenital malformation involving both dilatation of the extrahepatic bile duct and pancreaticobiliary maljunction. Persistent reflux of pancreatic juice injures the biliary tract mucosa, resulting in chronic inflammation and higher rates of carcinogenesis in the biliary tract, including the gallbladder. Telomeres are repetitive DNA sequences located at the ends of chromosomes. Chromosomal instability due to telomere dysfunction plays an important role in the carcinogenesis of many organs. This study was performed to determine whether excessive shortening of telomeres occurs in the gallbladder mucosa of patients with CBD. METHODS Resected gallbladders were obtained from 17 patients with CBD, ten patients with cholecystolithiasis without pancreatic juice reflux, and 17 patients with normal gallbladders (controls) (median age of each group of patients: 37, 50, and 53 years, respectively). The telomere lengths of the gallbladder epithelium were measured by quantitative fluorescence in situ hybridization using tissue sections, and the normalized telomere-to-centromere ratio (NTCR) was calculated. RESULTS The NTCRs in the CBD, cholecystolithiasis, and control groups were 1.24 [interquartile range (IQR) 1.125-1.52], 1.96 (IQR 1.56-2.295), and 1.77 (IQR 1.48-2.53), respectively. The NTCR in the CBD group was significantly smaller than that in the cholecystolithiasis and control groups (p = 0.003 and 0.004, respectively), even in young patients. CONCLUSIONS Our findings indicate that telomere shortening in the gallbladder mucosa plays an important role in the process of carcinogenesis in patients with CBD. These results support the recommendation of established guidelines for prophylactic surgery in patients with CBD because CBD is a premalignant condition with excessive telomere shortening.
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Affiliation(s)
- Yuto Aoki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
| | - Junko Aida
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Youichi Kawano
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Ken-Ichi Nakamura
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Naotaka Izumiyama-Shimomura
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Naoshi Ishikawa
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Nobuhiko Taniai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kaiyo Takubo
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Toshiyuki Ishiwata
- Research Team for Geriatric Pathology and Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
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Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC). World J Surg 2017; 41:538-545. [PMID: 27620132 DOI: 10.1007/s00268-016-3684-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreaticobiliary maljunctions (PBMs) are congenital anomalies of the junction between pancreatic and bile ducts, frequently associated with bile duct cyst (BDC). BDC is congenital biliary tree diseases that are characterized by distinctive dilatation types of the extra- and/or intrahepatic bile ducts. Todani's types I and IVa, in which dilatation involves principally the main bile duct, are the most frequent. PBM induces pancreatic juice reflux into the biliary tract that is supposed to be one of the main factors of biliary cancer degeneration, although the diagnostic criteria of PBM that can be either morphological and/or functional are not well defined especially in Western series. OBJECTIVE The aim of this study was to assess the relative prevalence of PBM in BDC in a large European multicenter study, to analyze the characteristics of PBM and try to propose diagnostic criteria of PBMs based on morphological and/or functional criteria and define the positive, negative predictive values, sensibility and specificity of either criteria. RESULTS From 1975 to 2012, 263 patients with BDC were analyzed. Among them, 190 (72.2 %) were considered to present PBM. Types I and IVa had a similar rate of PBM association. According to the "AFC classification," 57.2 % had a C-P type, 34.5 % a P-C type and 8.3 % a complex type ("anse-de-seau"). The median length of the common channel in patients with PBM was 15.8 ± 6.8 mm (range 5-40 mm). The median intrabiliary amylase and lipase levels were 65,249 and 172,104 UI/L, respectively. For the diagnostic of PBM, a common channel length of more than 8 mm and an intrabiliary amylase level superior to 8000 UI/L were associated with a predictive positive value and a specificity of more than 90 %. Synchronous biliary cancer had an incidence of 8.7 % in all patients with BDC and PBM 11.1 % in adults. Compared to type IV, the type I BDC was associated with statistically more cancer patients in the presence of PBM. CONCLUSIONS Characteristics of PBM associated with BDC in Western population are quite close to reported Eastern series. The results suggest considering both the intrabiliary value of amylase >8000 UI/L and a length of a common channel >8 mm as appropriate values for positive diagnosis of PBM.
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A case of pancreaticobiliary maljunction with a connecting duct without a long common channel. Clin J Gastroenterol 2017; 10:196-199. [PMID: 28229343 DOI: 10.1007/s12328-017-0723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall, usually forming an abnormally long common channel. In PBM, since the long common channel defeats the effect of the sphincter of Oddi, pancreatobiliary reflux frequently occurs, resulting in high rates of biliary tract cancers. We present the case of a 68-year-old female with advanced gallbladder cancer concomitant with bile duct cancer associated with PBM without biliary dilatation that had an extremely rare configuration showing a connecting duct without a long common channel. Pancreatography in the selectively cannulated main pancreatic duct showed the terminal portion of the common bile duct via an abnormal connecting duct. Cholangiography in the selectively cannulated lower bile duct showed the main and accessory pancreatic ducts via the connecting duct. The bile amylase level was markedly elevated. This case of a rare configuration of PBM with a connecting duct without a long common channel is the first such reported case in the English literature.
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Sugita R, Furuta A, Yamazaki T, Ito K, Noda Y. Pancreaticobiliary Juice Reflux in Patients With a Morphologically Normal Ductal System: Assessment Using Unenhanced MRI With Spin Labeling. AJR Am J Roentgenol 2017; 208:322-327. [DOI: 10.2214/ajr.16.16601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Reiji Sugita
- Department of Radiology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi 983-0824, Japan
| | - Akemi Furuta
- Department of Radiology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi, Japan
| | - Tetsuro Yamazaki
- Department of Radiology, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
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Kamisawa T, Kuruma S, Chiba K, Tabata T, Koizumi S, Kikuyama M. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol 2017; 52:158-163. [PMID: 27704265 DOI: 10.1007/s00535-016-1268-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023]
Abstract
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Because of the excessive length of the common channel in PBM, sphincter action does not directly affect the pancreaticobiliary junction, which allows pancreatic juice to reflux into the biliary tract. According to the results of a nationwide survey, bile duct and gallbladder cancers were found in 6.9 and 13.4 % of adult patients with congenital biliary dilatation, respectively, and in 3.1 and 37.4 % of those with PBM without biliary dilatation, respectively. Biliary tract cancers develop about 15-20 years earlier in patients with PBM than in individuals without PBM; they sometimes develop as double cancers. Carcinogenesis is strongly associated with stasis of bile intermingled with refluxed pancreatic juice. Epithelial cells in the biliary tract of PBM patients are under constant attack from activated pancreatic enzymes, increased secondary bile acids, or other mutagens. This can result in hyperplastic change with increased cell proliferation activity, and in turn, oncogene and/or tumor suppressor gene mutations in the epithelia, leading to the biliary tract carcinogenesis. The carcinogenesis of biliary tract cancer accompanying PBM is considered to involve a hyperplasia-dysplasia-carcinoma sequence induced by chronic inflammation caused by the reflux of pancreatic juice into the biliary tract, which differs from the adenoma-carcinoma sequence or the de novo carcinogenesis associated with biliary tract cancers in the population without PBM. Patients with a relatively long common channel have a similar, albeit slightly lower, risk for gallbladder cancer compared with PBM patients.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Taku Tabata
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satomi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Ishibashi H, Shimada M, Kamisawa T, Fujii H, Hamada Y, Kubota M, Urushihara N, Endo I, Nio M, Taguchi T, Ando H. Japanese clinical practice guidelines for congenital biliary dilatation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:1-16. [PMID: 28111910 DOI: 10.1002/jhbp.415] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Until now, there have been no practical clinical guidelines for congenital biliary dilatation (CBD). In this review article, the Japanese Study Group on Congenital Biliary Dilatation (JSCBD) propose to establish clinical practice guidelines for CBD. Because the evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 20 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs included the distinct aspects of CBD: (1) Concepts and Pathology (three CQs); (2) Diagnosis (six CQs); (3) Pancreaticobiliary Complications (three CQs); Treatments and Prognosis (eight CQs). Each statements and comments for CQs were made by the guidelines committee members. CQs were finally approved after review by members of the editorial committee and the guidelines evaluation board of CBD. These guidelines were created to provide assistance in the clinical practice of CBD management; their contents focus on clinical utility, and they include general information on CBD to make this disease more widely recognized.
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Affiliation(s)
- Hiroki Ishibashi
- Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Hideki Fujii
- First Department of Surgery, University of Yamanashi, Kofu, Japan
| | - Yoshinori Hamada
- Department of Pediatric Surgery, Kansai Medical University, Hirakata, Japan
| | - Masayuki Kubota
- Department of Pediatric Surgery, Niigata University, Niigata, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Itaru Endo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masaki Nio
- Department of Pediatric Surgery, Tohoku University, Sendai, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
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Fujimoto T, Ohtsuka T, Nakashima Y, Gotoh Y, Date K, Mori Y, Sadakari Y, Takahata S, Oda Y, Nakamura M. Elevated bile amylase level without pancreaticobiliary maljunction is a risk factor for gallbladder carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 24:103-108. [PMID: 28002646 DOI: 10.1002/jhbp.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elevated bile amylase level in patients with pancreaticobiliary maljunction (PBM) or high confluence of pancreaticobiliary ducts (HCPBD) is well known as a risk factor for gallbladder carcinoma (GBC) development. However, the effects of occult pancreaticobiliary reflux (OPR), a condition characterized by high bile amylase level in the presence of an anatomically normal pancreaticobiliary junction, on GBC development remain unclear. The aim of this study was to assess the relationship between OPR and GBC. METHODS Clinicopathological data of 52 patients who were preoperatively diagnosed with gallbladder (GB) tumor (22 malignant, 30 benign) were retrospectively reviewed. All of the patients underwent preoperative endoscopic retrograde cholangiopancreatography to evaluate pancreaticobiliary junction morphology and bile amylase level. The relationship between the histological diagnosis of GB lesions, and pancreaticobiliary junction morphology and bile amylase level were investigated. RESULTS Pancreaticobiliary maljunction, HCPBD, and normal pancreaticobiliary junction (NPJ) were identified in 12, nine, and 31 patients, respectively. The rates of GBC in patients with PBM, HCPBD, and NPJ were 58% (7/12), 67% (6/9), and 29% (9/31), respectively. Of the 31 patients with NPJ, 22 had OPR and nine of these had GBC. None of the patients with NPJ and normal bile amylase level had GBC. Additionally, among patients with NPJ, bile amylase level was significantly higher in patients with GBC than in patients with benign tumors. CONCLUSIONS Occult pancreaticobiliary reflux, like PBM and HCPBD, is a risk factor for GBC development.
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Affiliation(s)
- Takaaki Fujimoto
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takao Ohtsuka
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yohei Nakashima
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshitaka Gotoh
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenjiro Date
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhisa Mori
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Sadakari
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunichi Takahata
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Clinicopathologic Differences in Patients with Gallbladder Cancer According to the Presence of Anomalous Biliopancreatic Junction. World J Surg 2016; 40:1211-7. [PMID: 26630938 DOI: 10.1007/s00268-015-3359-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anomalous biliopancreatic junction (ABPJ) is a risk factor for gallbladder cancer (GBC). This study investigated the significance of ABPJ in patients with GBC. METHODS Of the 453 patients with GBC underwent surgery at Seoul National University Hospital between 2000 and 2014, the 401 patients who can be assessed for the presence of ABPJ with radiologic image were analyzed. RESULTS The 401 patients with GBC included 183 (45.6 %) males and 218 (54.4 %) females. ABPJ was identified in 69 (17.2 %) patients, 22 (31.9 %) males and 47 (68.1 %) females. Choledochal cyst (CC) was identified in 18 (4.5 %) patients, all of whom had ABPJ. Curative surgery was accomplished in 68.1 %. A comparison of patients with and without ABPJ showed that mean age (59.9 vs. 65.1 years, p < 0.001) and association with gallbladder stone (8.7 vs. 24.7 %, p = 0.002) were significantly lower in the ABPJ group, while the proportion of female (68.1 vs. 51.5 %, p = 0.012), bile duct resection rate (47.8 vs. 18.4 %, p < 0.001), and curative resection rate (81.1 vs. 65.7 %, p = 0.003) were significantly higher in the ABPJ group. Overall 5-year survival rates were similar in the ABPJ and non-ABPJ groups (74.4 vs. 69.0 %, p = 0.533). In patients with ABPJ, the presence of CC did not have a significant effect on survival (p = 0.099). CONCLUSIONS ABPJ was found in 17.2 % of patients with GBC. ABPJ is associated with younger age, female gender, absence of gallbladder stones, higher BDR rate, and higher curative resection rate. However, neither ABPJ nor CC was prognostic of survival in curatively treated patients with GBC.
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Ende AR, Irani S, Kozarek RA. Symptomatic pancreatic duct stones in the disconnected bile duct: A case series. Pancreatology 2016; 17:51-54. [PMID: 27889422 DOI: 10.1016/j.pan.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 11/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreaticobiliary maljunction (PBM) refers to the union of the pancreatic and biliary ducts outside of the duodenal wall. Patients are at increased risk of bile duct and gallbladder cancer, likely secondary to pancreatic juice refluxing into the biliary tree, and it is recommended that they undergo biliary diversion. METHODS This is a case series of all patients in our institution with PBM and bilioenteric anastomosis who presented with symptomatic pancreatic duct stones in a disconnected bile duct. IRB approval was obtained prior to the initiation of the study. RESULTS We describe eight cases of this finding. All patients underwent ERCP, with stones successfully removed from the disconnected bile duct in seven patients and from the pancreatic duct in one patient. CONCLUSION This novel finding has not been described in the medical literature, and may become more prevalent as more patients with PBM undergo bilioenteric anastomosis.
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Affiliation(s)
- Alexander R Ende
- Division of Gastroenterology, University of Washington, Seattle, WA, United States
| | - Shayan Irani
- Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA, United States
| | - Richard A Kozarek
- Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA, United States.
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Matsumoto M, Urushihara N, Fukumoto K, Yamoto M, Miyake H, Nakajima H. Laparoscopic management for prenatally diagnosed choledochal cysts. Surg Today 2016; 46:1410-1414. [PMID: 26935547 DOI: 10.1007/s00595-016-1319-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to validate our laparoscopic management strategy for asymptomatic and symptomatic patients with prenatally diagnosed choledochal cysts (CCs). METHODS Thirteen prenatally diagnosed CC patients from 1997 to 2015 were included. Seven patients (1997-2008) underwent open surgery (OS group), and 6 (2009-2015) underwent laparoscopic surgery (LS group). In the asymptomatic patients, LS was performed when the patients weighed over 5 kg. When the patient had clinical manifestations, early LS was performed irrespective of body weight. A retrospective comparison was conducted between the LS and OS groups in terms of the operative time, blood loss, postoperative fasting period, hospital stay, and intra- and postoperative complications. RESULTS There was no difference between the demographics of both groups. The operative time was significantly longer (380 vs. 288 min) and blood loss was significantly lower (4 vs. 30 mL) in the LS group. Additionally, the postoperative fasting period (3 vs. 6 days) and hospital stay (11 vs. 20 days) were significantly shorter in the LS group. Intraoperative events and early postoperative complications were not encountered in either group. Small bowel obstruction requiring surgery occurred in two patients, 10 and 13 years after OS, respectively. CONCLUSIONS LS is as safe and feasible as OS in small children with prenatally diagnosed CC, although sufficient pediatric laparoscopic expertise is mandatory.
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Affiliation(s)
- Mariko Matsumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Hideaki Nakajima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
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90
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Saito F, Araki K, Yokobori T, Ishii N, Tsukagoshi M, Watanabe A, Kubo N, Altan B, Shirabe K, Kuwano H. High expression of karyopherin-α2 and stathmin 1 is associated with proliferation potency and transformation in the bile duct and gall bladder epithelia in the cases of pancreaticobiliary maljunction. J Surg Oncol 2016; 114:462-8. [DOI: 10.1002/jso.24330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/05/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Fumiyoshi Saito
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Kenichiro Araki
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Takehiko Yokobori
- Department of Molecular Pharmacology and Oncology; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Norihiro Ishii
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Mariko Tsukagoshi
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Akira Watanabe
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Norio Kubo
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Bolag Altan
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery; Graduate School of Medicine; Gunma University; Maebashi Gunma Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science; Graduate School of Medicine; Gunma University; Showamachi, Maebashi Gunma Japan
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91
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Mizuguchi Y, Nakamura Y, Uchida E. Subsequent biliary cancer originating from remnant intrapancreatic bile ducts after cyst excision: a literature review. Surg Today 2016; 47:660-667. [DOI: 10.1007/s00595-016-1366-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/30/2016] [Indexed: 01/25/2023]
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92
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Saito T, Terui K, Mitsunaga T, Nakata M, Yoshida H. Significance of imaging modalities for preoperative evaluation of the pancreaticobiliary system in surgery for pediatric choledochal cyst. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:347-52. [DOI: 10.1002/jhbp.347] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/17/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Takeshi Saito
- Department of Pediatric Surgery (E6); Graduate School of Medicine, Chiba University; Chiba City Chiba Japan
| | - Keita Terui
- Department of Pediatric Surgery (E6); Graduate School of Medicine, Chiba University; Chiba City Chiba Japan
| | - Tetsuya Mitsunaga
- Department of Pediatric Surgery (E6); Graduate School of Medicine, Chiba University; Chiba City Chiba Japan
| | - Mitsuyuki Nakata
- Department of Pediatric Surgery (E6); Graduate School of Medicine, Chiba University; Chiba City Chiba Japan
| | - Hideo Yoshida
- Department of Pediatric Surgery (E6); Graduate School of Medicine, Chiba University; Chiba City Chiba Japan
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93
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Hamada Y, Ando H, Kamisawa T, Itoi T, Urushihara N, Koshinaga T, Saito T, Fujii H, Morotomi Y. Diagnostic criteria for congenital biliary dilatation 2015. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:342-6. [PMID: 26996969 DOI: 10.1002/jhbp.346] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Diagnostic Criteria for Pancreaticobiliary Maljunction 2013 were published by the Japanese Study Group on Pancreaticobiliary Maljunction (JSGPM) in 2014. The committee of JSGPM for diagnostic criteria for pancreaticobiliary maljunction has established the standard diameter of the bile duct, and a definition of dilatation of the bile duct was proposed in 2014. METHODS The committee of JSGPM prepared the diagnostic criteria for congenital biliary dilatation in 2014, and a final revised version was approved in 2015. RESULTS Congenital biliary dilatation is defined as a congenital malformation involving both local dilatation of the extrahepatic bile duct, including the common bile duct, and pancreaticobiliary maljunction. However, cases associated with intrahepatic bile duct dilatation can also be included. Various kinds of pathological conditions can occur on hepatobiliary systems and pancreas by bile duct dilatation and pancreaticobiliary maljunction. For a diagnosis of congenital biliary dilatation, both abnormal dilatation of the bile duct and pancreaticobiliary maljunction must be evident by either imaging test or anatomical examination. Acquired or secondary dilatation of the bile duct by obstruction due to biliary stones or malignancy should be strictly excluded. CONCLUSION Diagnostic criteria for congenital biliary dilatation 2015 were established from Japan representing a world first.
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Affiliation(s)
- Yoshinori Hamada
- Division of Pediatric Surgery, Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan.
| | | | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tsugumichi Koshinaga
- Division of Pediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Saito
- Department of Pediatric Surgery, Chiba University School of Medicine, Chiba, Japan
| | - Hideki Fujii
- First Department of Surgery, University of Yamanashi, Kofu, Japan
| | - Yoshiki Morotomi
- Division of Pediatric Surgery, Department of Surgery, Osaka City University School of Medicine, Osaka, Japan
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94
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Park JS, Song TJ, Park TY, Oh D, Lee HK, Park DH, Lee SS, Seo DW, Lee SK, Kim MH. Predictive Factors of Biliary Tract Cancer in Anomalous Union of the Pancreaticobiliary Duct. Medicine (Baltimore) 2016; 95:e3526. [PMID: 27196455 PMCID: PMC4902397 DOI: 10.1097/md.0000000000003526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The assessment of malignancies associated with anomalous union of the pancreaticobiliary duct (AUPBD) is essential for the design of appropriate treatment strategies. The aim of the present study is to measure the incidence of AUPBD-related pancreaticobiliary malignancy and to identify predictive factors. This retrospective cohort study included cases of 229 patients with AUPBD between January 1999 and December 2013. The impact of bile duct dilatation on the incidence of AUPBD-related pancreaticobiliary disease was measured, and predictive factors were evaluated.Among 229 patients with AUPBD, 152 had common bile duct dilatation (≥10 mm) (dilated group) and 77 did not (<10 mm) (nondilated group). Intrahepatic cholangiocarcinoma occurred more frequently in the nondilated group than in the dilated group (3.9% vs 0%; P < 0.05). By contrast, no significant difference in the incidence of extrahepatic cholangiocarcinoma was observed between the 2 groups (1.3% vs 3.9%; P = 0.271). By univariate analysis, age, type of AUPBD, and the level of pancreatic enzymes refluxed in the bile duct were associated with occurrence of biliary tract cancers. In multivariate analysis, age ≥45 years (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.011-1.073, P < 0.05), P-C type (OR 3.327, 95% CI 1.031-10.740, P < 0.05), and a high level of biliary lipase (OR 4.132, 95% CI 1.420-12.021, P < 0.05) showed a significant association with AUPBD-related biliary tract cancer.Intrahepatic cholangiocarcinoma may occur more frequently in AUPBD patients without bile duct dilatation. Age ≥45 years, P-C type, and biliary lipase level ≥45,000 IU/L are significantly associated with AUPBD-related biliary tract cancer.
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Affiliation(s)
- Jin-Seok Park
- From the Digestive Disease Center (J-SP), Department of Internal Medicine, Inha University School of Medicine, Incheon; Division of Gastroenterology (TJS, TYP, DO, DHP, SSL, DWS, SKL, M-HK), Asan Medical Center, University of Ulsan College of Medicine, Seoul; and Department of Internal Medicine (HKL), Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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95
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Huang SG, Guo WL, Wang J, Sheng M, Lan XH, Fang L. Factors Interfering with Delineation on MRCP of Pancreaticobiliary Maljunction in Paediatric Patients. PLoS One 2016; 11:e0154178. [PMID: 27104956 PMCID: PMC4841599 DOI: 10.1371/journal.pone.0154178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/08/2016] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to assess factors for delineating the pancreaticobiliary junction in the presence of pediatric congenital choledochal cysts (CCC) using Magnetic resonance cholangiopancreatography (MRCP). Methods Retrospective review of medical records for 48 patients with CCC was conducted, including demographics, biliary amylase and MRCP findings if available. With univariate and multivariate logistic regression, we measured significant factors affecting pancreaticobiliary maljunction(PBM) diagnoses by MRCP. Results Of the subjects enrolled with CCC. Twenty-eight cases had PBM according to MRCP. Univariate analysis confirmed that age, cyst diameter > 30 mm and cysts that descended to the introitus pelvis affected junctional delineation and detection of PBM (P<0.05). Stepwise logistic regression analysis confirmed large cysts in the introitus pelvis predicted pancreaticobiliary junctional delineation in MRCP and these data agreed with the literature. A correlation between cyst diameter and the length of the common channel was found as was cyst diameter and biliary amylase although there were no significant differences between them. Conclusions Age, cyst diameter >30 mm and descending cysts into the introitus pelvis affected junctional delineation of the pancreatic and bile duct in PBM with MRCP. Large cyst descension into the introitus pelvis was an independent factors affecting PBM detection.
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Affiliation(s)
- Shun-gen Huang
- General surgery department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Wan-liang Guo
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
- * E-mail:
| | - Jian Wang
- General surgery department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Mao Sheng
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Xing-hao Lan
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Lin Fang
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
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96
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Matsumoto T, Imai Y, Inokuma T. Neuroendocrine Carcinoma of the Gallbladder Accompanied by Pancreaticobiliary Maljunction. Clin Gastroenterol Hepatol 2016; 14:e29-30. [PMID: 26247168 DOI: 10.1016/j.cgh.2015.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Tomonori Matsumoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tetsuro Inokuma
- Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan
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97
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Kinowaki Y, Takazawa Y, Yamamoto N, Ishikawa Y. Intraductal papillary mucinous neoplasm involving pancreaticobiliary maljunction and an aberrant pancreatic duct draining into the stomach: A case report and review of the literature. Pathol Res Pract 2016; 212:139-44. [DOI: 10.1016/j.prp.2015.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 12/01/2022]
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98
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Bor R, Madácsy L, Fábián A, Szepes A, Szepes Z. Endoscopic retrograde pancreatography: When should we do it? World J Gastrointest Endosc 2015; 7:1023-1031. [PMID: 26322155 PMCID: PMC4549659 DOI: 10.4253/wjge.v7.i11.1023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde pancreatography (ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques (computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis (1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.
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99
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Ueno K, Ajiki T, Murakami S, Fujita T, Matsumoto T, Shinozaki K, Fukumoto T, Ku Y. Clinical significance of bile reflux into the pancreatic duct without pancreaticobiliary maljunction assessed by intraoperative cholangiography. Asian J Endosc Surg 2015; 8:296-302. [PMID: 25756368 DOI: 10.1111/ases.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Bile reflux into the pancreatic duct (BRPD) is sometimes demonstrated during intraoperative cholangiography (IOC) even in patients without pancreaticobiliary maljunction. However, the clinical significance of this finding in laparoscopic and open cholecystectomy is unclear. METHODS Among 484 patients who underwent cholecystectomy (372 laparoscopic, 112 open), patients whose pancreatic duct was depicted in IOC were selected. The value of pancreatic amylase (p-amylase) of the gallbladder bile, histological changes, and the immunohistochemical expression of proliferating cell nuclear antigen (PCNA) in the gallbladder mucosa were analyzed in patients with BRPD. The data were then compared to those in patients without BRPD whose gallbladder bile p-amylase was measured (control group, n = 20). RESULTS The success rate of IOC was 93.6%. The rate of BRPD in laparoscopic and open cholecystectomy was 5.2% and 5.7%, respectively. The value of gallbladder bile p-amylase in patients with BRPD was significantly higher than in the control group (790.5 vs 14.0 IU/L, P = 0.034). The value of the PCNA labeling index in patients with BRPD was significantly higher than that of the control group (15.4% vs 4.1%, P = 0.0026). Among the 24 patients with BRPD, pathological changes in the gallbladder mucosa were detected in five (two hyperplasia, three metaplasia), but there was no correlation between the presence of pathological change and PCNA labeling index or gallbladder bile p-amylase. CONCLUSIONS IOC could detect BRPD both in laparoscopic and open cholecystectomy at a similar rate. Patients with BRPD had high levels of gallbladder bile p-amylase and PCNA labeling index, findings similar to those in patients with pancreaticobiliary maljunction.
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Affiliation(s)
- Kimihiko Ueno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ajiki
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sae Murakami
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsunenori Fujita
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taku Matsumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenta Shinozaki
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yonson Ku
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Sugita R. Pancreaticobiliary reflux as a high-risk factor for biliary malignancy: Clinical features and diagnostic advancements. World J Hepatol 2015; 7:1735-1741. [PMID: 26167246 PMCID: PMC4491902 DOI: 10.4254/wjh.v7.i13.1735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/18/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreaticobiliary junction is composed of complex structure with which biliary duct and pancreatic duct assemble and go out into the ampulla of Vater during duodenum wall surrounding the sphincter of Oddi. Although the sphincter of Oddi functionally prevents the reflux of pancreatic juice, pancreaticobiliary reflux (PBR) occurs when function of the sphincter of Oddi halt. The anatomically abnormal junction is termed pancreaticobiliary maljunction (PBM) and is characterized by pancreatic and bile ducts joining outside of the duodenal wall. PBM is an important anatomical finding because many studies have revealed that biliary malignancies are related due to the carcinogenetic effect of the pancreatic back flow on the biliary mucosa. On the other hand, several studies have been published on the reflux of pancreatic juice into the bile duct without morphological PBM, and the correlation of such cases with biliary diseases, especially biliary malignancies, is drawing considerable attention. Although it has long been possible to diagnose PBM by various imaging modalities, PBR without PBM has remained difficult to assess. Therefore, the pathological features of PBR without PBM have not been yet fully elucidated. Lately, a new method of diagnosing PBR without PBM has appeared, and the features of PBR without PBM should soon be better understood.
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