Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement

Horaguchi, Jun; Fujita, Naotaka; Noda, Yutaka; Kobayashi, Go; Ito, Kei; Takasawa, Osamu; Obana, Takashi; Endo, Takuro; Nakahara, Kazunari; Ishida, Kazunari; Yonechi, Makoto; Hirasawa, Dai; Suzuki, Takashi; Sugawara, Toshiki; Ohhira, Tetuya; Onochi, Kengo; Harada, Yoshihiro

doi:10.1007/s00535-008-2158-9

Cited by 33 publications

(45 citation statements)

References 13 publications

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“…Of note, it has been demonstrated that biliary amylase levels of 10,000 IU/L or higher can be detected in 6 and 10.8 % of patients with biliary tract malignancies and benign biliary tract disease, respectively [59]. Elsewhere, it has been proposed that even in individuals whose papillary sphincter does act on the pancreaticobiliary junction, biliary amylase levels may be elevated to mean values of 48,000 IU/L if their common channel is sufficiently long, although such levels are still lower than the mean values seen in patients with PBM [3].…”

Section: Commentsmentioning

confidence: 98%

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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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Section: Commentsmentioning

confidence: 98%

“…Therefore, an increase in the levels of amylase in the bile is strong evidence of pancreatobiliary reflux [2]. A level of biliary amylase distinctly above the normal upper limit has been used as a diagnostic criterion in different reports [26,58,59], including levels of 500 IU/L [60] and 1,000 IU/L or higher [61].…”

Section: Commentsmentioning

confidence: 99%

Japanese clinical practice guidelines for pancreaticobiliary maljunction

et al. 2012

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“…[5,8,13,15,16] Although, it is unclear whether the stones causes PBR or vice versa, our observation of PBR in patients with acute calculous cholangitis is compatible with the results of others that conducted studies on occult PBR in patients with a normal pancreatobiliary junction. [6,14] However, there is still no definitive knowledge of exactly what this occult PBR means clinically.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[6,8,13,14] Some researchers hypothesized that papillitis due to stones causes dysfunction of the sphincter of Oddi, which then leads to reflux of pancreatic juice. [14] In contrast, others suggested that reflux of pancreatic juice causes chronic inflammation of the gallbladder, which subsequently results in gallstone formation. [5,8,13,15,16] Although, it is unclear whether the stones causes PBR or vice versa, our observation of PBR in patients with acute calculous cholangitis is compatible with the results of others that conducted studies on occult PBR in patients with a normal pancreatobiliary junction.…”

Section: Discussionmentioning

confidence: 99%

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Common Bile Duct Stones Associated with Pancreatobiliary Reflux and Disproportionate Bile Duct Dilatation

Lee¹,

Park²,

Paik³

et al. 2009

Gastrointestinal Endoscopy

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A case of occult pancreaticobiliary reflux due to endoscopically confirmed relaxation of the Oddi sphincter

et al. 2022

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An otherwise healthy 45‐year‐old woman had been experiencing intermittent right upper abdominal pain for the past 1 year. Computed tomography showed pneumobilia and pancreatic duct emphysema despite a normal duodenal papilla. Magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed bile duct dilation but without a pancreaticobiliary maljunction. Duodenoscopy detected a slightly sunken, unfixed, and spontaneously enlarged duodenal papilla. During the cholangiogram, the Oddi sphincter was relaxed and the catheter could be easily inserted into the bile duct. Further, no findings suggestive of pancreaticobiliary maljunction were observed, and the contrast medium leaked spontaneously from the duodenal papilla. As biliary amylase level was high, we surmised the occurrence of occult pancreaticobiliary reflux due to relaxation of the Oddi sphincter. However, as there are no guidelines on the management of this condition, we did not offer any treatment. Nevertheless, the patient continued to experience similar symptoms and was retested 1 year later with similar results. As occult pancreaticobiliary reflux was reconfirmed, we suggested that the patient undergo laparoscopic extrahepatic bile duct resection and cholecystectomy, which is the standard treatment for pancreaticobiliary maljunction. Pathological evaluation revealed fibrous thickening of the bile duct wall and chronic cholecystitis, which are typical findings of pancreaticobiliary reflux. Even though pancreaticobiliary reflux is mainly observed in pancreaticobiliary maljunction, it has also been reported in normal patients. Here, we describe a novel mechanism of pancreaticobiliary reflux, namely, a relaxed or defective Oddi sphincter.

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Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement

Abstract: Occult pancreaticobiliary reflux is observed in a considerable number of ERCP candidates. Those who show an extremely high biliary amylase level, at least, may be at high risk for biliary malignancies.

Cited by 33 publications

References 13 publications

Japanese clinical practice guidelines for pancreaticobiliary maljunction

Japanese clinical practice guidelines for pancreaticobiliary maljunction

Common Bile Duct Stones Associated with Pancreatobiliary Reflux and Disproportionate Bile Duct Dilatation

A case of occult pancreaticobiliary reflux due to endoscopically confirmed relaxation of the Oddi sphincter

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