Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction

Sai, Jin Kan; Suyama, Masafumi; Kubokawa, Yoshihiro; Tadokoro, Hiroyuki; Sato, Nobuhiro; Maehara, Tadayuki; Iida, Yoshito; Kojima, Kuniaki

doi:10.1067/mge.2003.53

Cited by 53 publications

(69 citation statements)

References 14 publications

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“…SMRCP is considerably sensitive in detecting MPBM and OPR; hence, a negative result in SMRCP imaging indicates the absence of pancreatobiliary reflux. Although bile collection is the only available method to diagnose OPR, it is possible to use SMRCP as a screening tool [6,7]. Fig.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent investigations have demonstrated the occurrence of pancreatobiliary reflux in patients with a normal pancreatobiliary junction [this has been termed as "occult pancreatobiliary reflux" (OPR)]; this was indicated by a higher amylase level in CBD bile than in serum [6,7]. It has been proved that OPR might also be a risk factor for biliary malignancies [8].…”

Section: Introductionmentioning

confidence: 99%

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Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

et al. 2007

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We propose the hypothesis that the enlargement of the common bile duct (CBD) or gallbladder (GB) that is occasionally demonstrated on magnetic resonance cholangiopancreatography (MRCP) after secretin stimulation is caused by pancreatobiliary reflux. Recently, occult pancreatobiliary reflux (OPR) has been demonstrated in patients without morphological pancreatobiliary maljunction (MPBM). The aim of this study was to evaluate the efficacy of secretin-stimulating MRCP (SMRCP) in the diagnosis of pancreatobiliary reflux. The study included 14 patients with MPBM and 32 patients with a normal pancreatobiliary junction. OPR was evaluated by bile collection and diagnosed in seven of the 32 patients. All the patients underwent SMRCP; the related findings were considered positive when enlargement of the CBD or GB was observed. Positive findings on SMRCP were observed in all MPBM patients. In the patients with normal pancreatobiliary junction, there was significant difference between the mean amylase levels in the patients with positive and negative SMRCP findings (mean, 4,755.7 and 29.7 IU/l). The sensitivity and specificity of SMRCP for diagnosing OPR was 85.7% and 68.0%, respectively. SMRCP provides a non invasive method for excluding PBR and can identify patients who could benefit from bile duct sampling to diagnose OPR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

et al. 2007

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“…Se ha reportado que la vimentina es un marcador de células proliferativas en los conductos pancreáticos 16 , sin embargo otros estudios reportaron inmunorreactividad negativa para vimentina en células de los conductos pancreáticos 9 , este hecho se confirma en nuestros casos, en los que ninguna estructura tubular pancreática fue reactiva a vimentina. Las estructuras tubulares y epiteliales fueron inmunorreactivas a citokeratinas 7,8,18,19,20 y a CA19-9; las estructuras epiteliales fueron reactivas a villina y CEA. La actividad exocrina fue documentada mediante inmunorreactividad a α1-antitripsina y α1-quimotripsina.…”

Section: A S O S C L í N I C O Sunclassified

“…El análisis inmunohistoquímico fue negativo para vimentina y antíge-no carcinoembrionario (CEA). El parénquima pancreático, acinos e islotes endocrinos fueron inmunorreactivos para α1-antitripsina, α1-quimotripsina, insulina, villina, somatostatina (Figura 1), sinaptofisina y cromogranina A. El epitelio vesicular y de los conductos pancreáticos fue inmunorreactivo para citokeratinas 7,8,18,19,20; y CA19-9.…”

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Coristoma pancreático en la vesícula biliar: Reporte de dos casos

Beltrán

Barría²,

Naquira³

et al. 2007

Rev. méd. Chile

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Pancreatic choristoma is the ocurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder 7,8,18,. Exocrine activity was documented by immunoreactivity to α1-antitrypsin and α1-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity (Rev Méd Chile 2007; 135: 1318-22 E l páncreas heterotópico, también conocido como coristoma pancreático, es la presencia de tejido pancreático normal en una localización anormal sin relación anatómica con la glándula principal 1 . La presencia de tejido heterotópico es infrecuente en la vesícula biliar. Se han reportado casos de mucosa gástrica, hígado, glándula suprarrenal y páncreas 2-4 . La heterotopia pancreática ha sido descrita en pacientes adultos y pediátricos, con un rango de edad que varía entre 6 y 77 años 5,6 . Las localizaciones más frecuentes fueron: estómago, duodeno, yeyuno y divertículo de Meckel. En la vesícula biliar han sido reportados 31 casos 4,7-10 , los síntomas que desarrollan estos pacientes se presentan típicamente cuando el coristoma en la vesícula es de tejido gástrico, llevando a hemobilia o colecistitis aguda y a colecistitis aguda o pancreatitis aguda cuando es pancreático 6,10 . Todos los casos publicados de coristomas pancreáticos vesiculares fueron encontrados incidentalmente durante el examen histoló-gico de vesículas operadas electivamente o de

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“…Recently, Sai et al [32 ]demonstrated enhanced visualization of intra- and extrahepatic bile duct and gallbladder with increased maximal diameter of the extrahepatic bile duct and short axis of the gallbladder on secretin-stimulated dynamic MRCP in 4 of 74 patients (5%) who had a normal pancreaticobiliary junction on ERCP. The amylase level of the bile was markedly elevated in all 4 patients, and 3 of these 4 patients had gallbladder cancer.…”

Section: Diagnosis Of Pancreatobiliary Refluxmentioning

confidence: 99%

Biliopancreatic and Pancreatobiliary Refluxes in Cases with and without Pancreaticobiliary Maljunction: Diagnosis and Clinical Implications

Kamisawa¹,

Okamoto

2006

Digestion

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The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice. A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall, as occurs in pancreaticobiliary maljunction; in such cases, the action of the sphincter does not functionally affect the junction. Thus, biliopancreatic and pancreatobiliary refluxes occur, resulting in various pathological conditions in the biliary tract and in the pancreas. Biliopancreatic reflux could be confirmed by operative or postoperative T tube cholangiography, computed tomography combined with drip infusion cholangiography, histological detection of gallbladder cancer cells in the main pancreatic duct, and reflux of bile on the cut surface of the pancreas. Pancreatobiliary reflux could be diagnosed on the basis of an elevated amylase level in the bile, secretin-stimulated dynamic magnetic resonance cholangiopancreatography, and pancreatography via the minor duodenal papilla. Recently, it has become obvious that these refluxes can occur in individuals without pancreaticobiliary maljunction. Biliopancreatic reflux is related to the occurrence of acute pancreatitis, and pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without pancreaticobiliary maljunction. Since few systemic studies exists with respect to diagnostic imaging techniques and clinical relevance of these refluxes in individuals with a normal pancreaticobiliary junction, further prospective clinical studies including appropriate management should be performed.

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Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction

Cited by 53 publications

References 14 publications

Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

Coristoma pancreático en la vesícula biliar: Reporte de dos casos

Biliopancreatic and Pancreatobiliary Refluxes in Cases with and without Pancreaticobiliary Maljunction: Diagnosis and Clinical Implications

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