Mechanism of pancreatic juice reflux in pancreaticobiliary maljunction: A fluid dynamics model experiment

Abstract

Background Pancreatic juice reflux to the common bile duct and gallbladder is observed in the pancreaticobiliary maljunction (PBM), and various pathological conditions occur in the biliary tract. However, the mechanism of pancreatic juice reflux has not been discussed yet. This study aimed to investigate the mechanism of this phenomenon from the perspective of the fluid dynamics theory. Methods A fluid dynamics model of PBM without biliary dilatation having gallbladder function and of the pressure of sphincter of Oddi was developed. Water (as bile juice and pancreatic juice) was flowed to these models with a flow rate similar to that in humans. Pancreatic and bile juice flow and bile duct pressure were observed in three phases of gallbladder function. Moreover, the same experiment was performed in the PBM without biliary dilatation model without gallbladder. Results Pancreatic juice reflux could be observed when the gallbladder was passively expanded with the pressure in the bile duct lower than that in the sphincter of Oddi. However, pancreatic juice reflux was not observed in the model without gallbladder. Conclusions Gallbladder function may be strongly involved in pancreatic juice reflux in PBM without biliary dilatation. Cholecystectomy may be able to stop the reflux of pancreatic juice.

Common bile duct pressure in patients with and without cholelithiasis: A case‐control study

“…This is the anatomic basis on which we postulate that some form of SO malfunction affecting one or all its components is the cause of the reflux of pancreatic enzymes. Recent experimental research by Fukuzawa 21 states that the pressure of the SO is constant and that pancreatic juice reflux is observed when the SO pressure is higher than the common bile duct pressure but not with lower pressure, additionally supporting our hypothesis. The human bile duct lacks a contractile muscle layer 8,9,20,22‐27 .…”

“…Moreover, it has been experimentally demonstrated that the contraction of the gallbladder releasing bile into the common bile duct also affects the intraductal pressure. 21 Normal sphincter activity directs the flow of bile and pancreatic juice towards the duodenum by antegrade phasic contractions. [28][29][30] Consequently, in patients with pancreatobiliary reflux with normal pancreatobiliary junction, the only plausible explanation for reflux of pancreatic juice into the biliary tract is an anomaly in the SO normal function causing a functional obstruction to the normal flow and retrograde contractions spasms the reflux of pancreatic juice into the biliary tract, because the intraluminal pressure of the pancreatic duct is higher than CBD intraluminal pressure.…”

“…Therefore, the flow of bile and pancreatic juice towards the duodenum is a consequence of gallbladder activity and intraductal bile and pancreatic duct pressure, which depend on the production of bile and pancreatic juice respectively, and is regulated by SO. Moreover, it has been experimentally demonstrated that the contraction of the gallbladder releasing bile into the common bile duct also affects the intraductal pressure 21 . Normal sphincter activity directs the flow of bile and pancreatic juice towards the duodenum by antegrade phasic contractions 28‐30 .…”

Presiones De La via Biliar en Pacientes Con Y Sin Colelitiasis

“…Esta es la base anatómica sobre la cual postulamos a la disfunción de uno o todos los componentes del EO como la causa del RPB. Recientemente, Fukuzawa publicó los resultados de un estudio experimental en el que demostró que la presión del EO es constante y que es posible observar RPB cuando la presión del EO se eleva significativamente sobre la presión de la VBE, este fenómeno no se observó con presiones bajas del EO 20 . El estudio de Fukuzawa constituye nueva evidencia que apoya nuestros resultados.…”

Nadir Bir Konjenital Safra Anomalisi: Pankreatikobiliyer Bilişim Anomalisi

“…In patients with APBJ, pancreaticobiliary reflux often causes biliary cancer, biliopancreatic reflux often causes acute or chronic pancreatitis. Bile ducts DOI: 10.37990/medr.865798 of APBJ patients are considered premalignant and prophylactic surgery is recommended as soon as the diagnosis is made (7)(8)(9). In ERCP (endoscopic retrograde cholangiopancreotography), a long common duct, an abnormal bile-pancreatic duct junction and a contraction sphincter distal to the union are features of APBJ.…”