title: Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction.
abstract: BACKGROUND
  The aim of this study was to investigate pancreatobiliary reflux in individuals with a normal pancreaticobiliary junction.
  
  
  METHODS
  Seventy-four patients with a normal pancreaticobiliary junction, as determined by ERCP, underwent secretin injection MRCP before cholecystectomy. Based on changes in the diameter of the biliary system after secretin injection, patients were categorized into enhanced or nonenhanced groups.
  
  
  RESULTS
  Biliary amylase was measured in the 4 patients allocated to the enhanced group and 60 in the nonenhanced group. The mean (SD) biliary amylase level in the gallbladder was 123,723 (115,125) IU/L in the enhanced group and 238 (507) IU/L in the nonenhanced group (p < 0.0001). The mean (SD) biliary amylase level in gallbladders with carcinoma (n = 7) was 68,281 (106,500) IU/L, which was significantly higher than that in gallbladders without carcinoma (p < 0.01).
  
  
  CONCLUSIONS
  Pancreatobiliary reflux similar to that seen in patients with pancreaticobiliary maljunction can occur in individuals with a normal pancreaticobiliary junction and may be associated with carcinoma of the gallbladder. Secretin injection MRCP is useful for identifying these individuals.
authors.affiliation: Department of Gastroenterology, Juntendo University, Tokyo, Japan.
authors.forename: Jin Kan
authors.initials: JK
authors.lastname: Sai
authors.forename: Masafumi
authors.initials: M
authors.lastname: Suyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kubokawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tadokoro
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sato
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Maehara
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iida
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Kojima
mesh_terms: D000681:Amylases / Q000032:analysis; D001646:Bile / Q000737:chemistry; D001652:Bile Ducts / Q000033:anatomy & histology*; D001655:Bile Reflux / Q000503:physiopathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005705:Gallbladder Diseases / Q000503:physiopathology; D005706:Gallbladder Neoplasms / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000033:anatomy & histology*; D012633:Secretin
chemical_list: D012633:Secretin; D000681:Amylases