Endoscopic diagnosis of pancreaticobiliary maljunction

Abstract

Pancreaticobiliary maljunction (PBM) is a congenital ano maly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dila tation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophy lactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERCP) is the most effective examination method for close observation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphincter on ERCP, PBM is diagnosed. In these patients, levels of pancreatic enzymes in the bile are generally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3Dcomputed tomo graphy can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultrasonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of associated biliary cancer. Gallbladder wall thickness on ultrasonography can be a screening test for PBM.

Anomalous union of the pancreaticobiliary duct without choledochal cyst: is cholecystectomy alone sufficient?

“…The frequency of encountering AUPBD in patients undergoing ERCP ranges from 0.9 to 8.7 % depending on the type of diagnostic modalities used, the study population, and the country where the study had been conducted [6]. The prevalence of AUPBD in our study was 0.54 % which is somewhat lower than that of Japan (1.5 to 3.2 %), but was significantly more common in women than in men which is similar to previous reports [15,18,19]. It is well known that AUPBD is commonly associated with choledochal cyst and carcinomas of the biliary tract, i.e., bile duct and gallbladder.…”

“…AUPBD is a rare congenital condition reported to be found more commonly in Asian countries than in Western countries, particularly in women [18]. The frequency of encountering AUPBD in patients undergoing ERCP ranges from 0.9 to 8.7 % depending on the type of diagnostic modalities used, the study population, and the country where the study had been conducted [6].…”

Postcholecystectomy Syndrome: From Pathophysiology to Differential Diagnosis - A Critical Review

“…There is an increased risk of development of cholangiocarcinoma within the cyst and also for gallbladder carcinoma due to pancreaticobiliary reflux of the pancreatic juice that must be taken into consideration during the follow-up. ERCP and endoscopic manometry seem to be useful in clarifying the pathophysiology of symptomatic choledochocele and ACPBD [20][21][22][23]. Several reports suggested that juxtapapillary diverticulum (JPD) might cause symptoms or diseases of the biliary and pancreatic duct.…”

Nadir Bir Konjenital Safra Anomalisi: Pankreatikobiliyer Bilişim Anomalisi

“…Pancreatic duct and common bile duct open to the second part of the duodenum by a short common canal, usually 1-12mm in length (1). The normal length of this canal being longer than 15 mm is a congenital malformation and it is called anomalous pancreaticobiliary junction (APBJ).…”