title: Surgical treatment for non-dilated biliary tract with pancreaticobiliary maljunction should include excision of the extrahepatic bile duct.
abstract: OBJECTIVE
  The authors evaluated the surgical treatment for non-dilated biliary tract with pancreaticobiliary maljunction.
  
  
  METHODS
  Sixty-nine patients with pancreaticobiliary maljunction were divided into 61 patients with the dilated biliary tract and 8 with the non-dilated biliary tract. The levels of amylase activity in the bile in the gallbladder and the bile duct, the incidence and severity of postoperative cholangitis, and cell proliferating activity of the biliary tract epithelium, examined the proliferating cell nuclear antigen labeling index (PCNALI), were examined.
  
  
  RESULTS
  Of the 61 dilated type patients, 12 were of Ia, 1 was of Ib, 22 were of Ic, 25 were of IV-A, and 1 was of IV-B according to Todani's classification. Cancer was detected in 7 dilated type patients and in 3 non-dilated type patients. A high level of amylase activity was measured in the bile juice in both the gallbladder and bile duct in all of the patients with pancreaticobiliary maljunction. PCNALI of the biliary tract epithelium of the patients without cancer (dilated type: bile duct 11.4%, gallbladder 12.7%; non-dilated type: bile duct 5.9%, gallbladder 13.8%) was higher than that of the patients without pancreaticobiliary maljunction (bile duct 1.5%, gallbladder 1.4%).
  
  
  CONCLUSIONS
  In a non-dilated type, as well as in a dilated type, a high level of amylase activity and increase of cell proliferative activity of the biliary tract epithelium were observed. Therefore, these results suggest that the extrahepatic bile duct should be prophylactically removed in patients with non-dilated type as well as in those with dilated type pancreaticobiliary maljunction.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. sur049@poh.osaka-med.Ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Hara
authors.forename: S
authors.initials: S
authors.lastname: Morita
authors.forename: T
authors.initials: T
authors.lastname: Ishibashi
authors.forename: S
authors.initials: S
authors.lastname: Sako
authors.forename: T
authors.initials: T
authors.lastname: Dohi
authors.forename: M
authors.initials: M
authors.lastname: Iwamoto
authors.forename: N
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000681:Amylases / Q000378:metabolism; D001646:Bile / Q000201:enzymology; D001650:Bile Duct Neoplasms / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000601:surgery; D002761:Cholangitis / Q000209:etiology; D004108:Dilatation, Pathologic; D004386:Duodenum / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007582:Jejunostomy; D008099:Liver / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D000681:Amylases