Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union

Jeong, In-Ho; Jung, Yongsik; Kim, Hong; Kim, Bong-Wan; Kim, Jungwoon; Hong, Jeong Yeon; Wang, Hee-Jung; Kim, Myung-Wook; Yoo, Byung Moo; Kim, Jin Hong; Han, Jae‐Ho; Kim, Wook Hwan

doi:10.3748/wjg.v11.i13.1965

Cited by 25 publications

(18 citation statements)

References 23 publications

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“…17 In our present study, as the size of choledochal cyst increased, the grade of inflammation was raised and anastomotic stricture increased. The high grade of inflammation was related with cyst wall thickening, but no relation with fibrosis grade.…”

Section: Discussionsupporting

confidence: 55%

“…In children, there are different levels of biliary amylase, [17][18][19] and postoperative complications are less common than in adults. 5,6,[8][9][10]16,20,21 Yamataka et al 20 studied anastomotic stricture that developed in four patients who underwent operation under 19 years of age, respectively, and found that increase of age had increased incidence because there were no anastomotic strictures in 145 children who underwent operation at 5 years or younger.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Kim

Choi

Han

et al. 2008

Journal of Gastrointestinal Surgery

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The aim of this study was to investigate the risk factors of postoperative anastomotic stricture after excision of choledochal cysts and hepaticojejunostomy. Among 65 patients who underwent surgery for choledochal cyst between March 1995 and June 2005, we selected 34 adult patients who were diagnosed as having choledochal cyst. We divided patients into two groups, depending on postoperative anastomotic stricture developed or not. Medical records and radiological findings of each patient were reviewed retrospectively. H&E stain and Masson-Trichrome stain of each specimen of the resected cyst were performed, and thickness of cyst wall, the grade of fibrosis, loss of smooth muscle layer, loss of mucosa, and infiltration of inflammatory cells were measured. Of the 34 patients, excision of choledochal cyst and hepaticojejunostomy were done in 33 patients, and 1 patient with chronic pancreatitis underwent pylorus-preserving pancreaticoduodenectomy. Anastomotic stricture and intrahepatic duct stones postoperatively developed in eight patients; one patient of 19 type I cyst and seven patients of 15 type IVa, developing significantly more in the type IVa choledochal cyst (P<0.05). The size of choledochal cyst in the stricture group was 7.0 cm, and that of the non-stricture group, 4.2 cm, showing significant difference between the two groups (P<0.05). The stricture group presented shorter duration of symptoms (27.63±61.72 days; ranged, 1∼180 days) than the non-stricture group (483.33±916.41 days; ranged, 1∼3,560 days), and it was statistically significant (P<0.05). Pathologically, significant difference was found between anastomotic stricture and infiltration of inflammatory cells (P<0.05). The results indicate that anastomotic stricture is influenced by the type IVa choledochal cyst, size of cyst, duration of symptoms, and the grade of infiltration of inflammatory cells. Therefore, closed careful follow-up is important in patients who underwent cyst excision with hepaticojejunostomy for type IVa choledochal cyst. If the anastomotic stricture develops, nonoperative management should be recommended, rather than operation, as much as possible.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Kim

Choi

Han

et al. 2008

Journal of Gastrointestinal Surgery

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“…The biliary amylase levels in PBM are often at least 10,000 IU/L (Table 1) [26,[62][63][64]. However, patients with bile duct stones or those with decreased exocrine pancreatic function may sometimes not show elevated biliary amylase levels even if they suffer from PBM [65].…”

Section: Commentsmentioning

confidence: 99%

Japanese clinical practice guidelines for pancreaticobiliary maljunction

et al. 2012

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There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of 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 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.

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“…A lack of sphincter function, due to abnormal anatomical junction of the pancreaticobiliary ductal system, in combination with a pressure difference between the duodenum and the sphincter of Oddi is proposed to convey the reflux of pancreatic juice into the biliary system [37,46]. Numerous authors suggest a sequence of pancreatobiliary reflux, inflammation, dysplasia followed by biliary stasis, which finally leads to increased mutagenicity and carcinoma [15,45,[47][48][49]. Molecular events in carcinogenesis are still poorly understood and provided elsewhere [8].…”

Section: Malignancymentioning

confidence: 99%

Recent developments in the diagnosis and treatment of bile duct cysts: a review

et al. 2011

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Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union

Abstract: The results support the notion that amylase has a particular role in the onset of symptoms, and suggest that a large amount of biliary amylase induces early onset of symptom, thereby making early diagnosis possible.

Cited by 25 publications

References 23 publications

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Japanese clinical practice guidelines for pancreaticobiliary maljunction

Recent developments in the diagnosis and treatment of bile duct cysts: a review

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