Clinical study of choledochocele: is it a risk factor for biliary malignancies?
BACKGROUND
We aimed to clarify the clinical characteristics of choledochocele and to evaluate the possibility of choledochocele as a risk factor for biliary malignancies.


METHODS
The clinical feature, the configuration of the pancreatobiliary ductal system, coexistent pancreatobiliary lesions, and amylase level in bile in 21 patients with choledochocele were reviewed. The correlation between the configuration, comorbid diseases, and amylase level in the bile was investigated.


RESULTS
There was a female predominance, and 57% of the patients showed abdominal pain. Quite a few patients showed elevation of the levels of hepatobiliary enzymes. The configuration of the pancreatobiliary ductal system and choledochocele was classified into two categories: type I, where the choledochocele and pancreatic duct were visualized independently or simultaneously (90.5%); and type II, where the pancreatic duct was visualized after filling of the choledochocele (9.5%). Among coexistent bilio-pancreatic diseases, biliary stone diseases were the most frequent. Biliary malignancy was seen in 3 patients (14.3%). The amylase level in the bile was high in 50% (4/8) of the patients examined. The rate of abnormal elevation of amylase level in the bile in the two types of pancreatobiliary ductal system and choledochocele was 3/7 and 1/1, respectively.


CONCLUSIONS
The prevalence of organic abnormal arrangement of the pancreatobiliary ductal system in which the choledochocele serves as a common channel is low. However, there are patients with suspected functional abnormal arrangement of the pancreatobiliary ductal system, who may possibly be a high-risk group for biliary malignancy.
Horaguchi
Jun
J
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan.
Fujita
Naotaka
N
Kobayashi
Go
G
Noda
Yutaka
Y
Ito
Kei
K
Takasawa
Osamu
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000681:Amylases / Q000097:blood*; D001646:Bile / Q000201:enzymology*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D000681:Amylases