Classification of pancreaticobiliary maljunction and its clinical features in adults

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.

Pancreaticobiliary maljunction: a rare finding on a routine intra‐operative cholangiogram with significant implications

“…4 PBM without biliary dilatation, (Type-B, as seen in our patient), are often asymptomatic and, therefore, usually diagnosed incidentally during adulthood, often concurrently with advanced biliary tract malignancy. 4 Due to its association with biliary cancers, the treatment recommendation for adults with PBM and CBD is extrahepatic bile duct resection. 3 The treatment recommendation for PBM without biliary dilatation remains contentious.…”

“…Patients may present with intermittent abdominal pain, jaundice or an elevated amylase level. 1,4 When associated with CBD a classical triad of abdominal pain, jaundice and an abdominal mass has been described. 3 Children are more likely to be symptomatic from PBM regardless of subtype as are those with associated CBD.…”

Efficacy of superb microvascular imaging of ultrasound for diagnosis of gallbladder lesion

“…The diagnosis and treatment of GB lesions have been well discussed. [15][16][17][18][19][20][21] In particular, the differentiation between benign lesions and malignant lesions is a major issue of concern. Various approaches have been attempted for the accurate diagnosis of GB lesions including analysis of the enhancement pattern on contrast-enhanced US (CE-US) or contrast-enhanced EUS (CE-EUS).…”

“…The diagnosis and treatment of GB lesions have been well discussed 15‐21 . In particular, the differentiation between benign lesions and malignant lesions is a major issue of concern.…”

Risk Factors Associated with Acute Pancreatitis after Percutaneous Biliary Intervention: We Do Not Know Nearly Enough

“…PBM is a congenital deformity in which the pancreatic and bile ducts unite anatomically outside the duodenal wall to form a long common channel [37]. It contributes to pancreatitis by causing a temporary or persistent obstruction of pancreatic juice or bile reflux into the pancreatic duct (biliopancreatic reflux) [38], followed by increased pressure in the pancreatic duct. A study found that PBM was one of the pathogenic factors of pancreatitis [39].…”