Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases.
OBJECTIVE
It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases.


METHODS
One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study.


RESULTS
According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001).


CONCLUSIONS
OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.
Beltrán
Marcelo A
MA
Department of Surgery, Hospital de Ovalle, Ovalle, Chile. beltran_01@yahoo.com
Vracko
Jozef
J
Cumsille
Miguel A
MA
Cruces
Karina S
KS
Almonacid
Jorge
J
Danilova
Tatiana
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis*; D001646:Bile / Q000201:enzymology*; D001649:Bile Duct Diseases / Q000201:enzymology / Q000209:etiology*; D001655:Bile Reflux / Q000201:enzymology / Q000209:etiology*; D002764:Cholecystitis / Q000150:complications / Q000201:enzymology; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000201:enzymology; D005706:Gallbladder Neoplasms / Q000150:complications*; D006801:Humans; D008049:Lipase / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000201:enzymology / Q000209:etiology*
D008049:Lipase; D000681:Amylases