Pancreatobiliary reflux and the length of a common channel.
OBJECTIVE
Gallbladder cancer occurs frequently in patients with pancreaticobiliary maljunction due to pancreatobiliary reflux. Pancreatobiliary reflux is also detected in some patients with a relatively long common channel. This study aimed to clarify the correlation between pancreatobiliary reflux and the length of a common channel.


METHODS
Two hundred and three patients, in whom both the length of a common channel and amylase level in the bile were measured, were enrolled from nine centers.


RESULTS
Bile amylase level was correlated with the length of a common channel (P < 0.01). The minimum length of a common channel that could induce a markedly elevated amylase level in the bile (>1,000 mg/dl) was determined as 5 mm. We redefined high confluence of pancreatobiliary ducts (HCPBD) as cases with a common channel > or = 5 mm, in which the communication between the pancreatic and bile ducts was occluded with the sphincter contraction. Gallbladder cancer was found in 20% of 56 redefined HCPBD patients. Bile amylase level >1,000 mg/dl and biliopancreatic reflux were detected in 79 and 95% of the patients, respectively.


CONCLUSIONS
Patients with a common channel > or = 5 mm (redefined HCPBD) should be monitored for the development of gallbladder cancer, as they frequently showed significant pancreatobiliary reflux.
Kamisawa
Terumi
T
Department of Internal Medicine, Tokyo Metropolitan, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. kamisawa@cick.jp
Suyama
Masafumi
M
Fujita
Naotaka
N
Maguchi
Hiroyuki
H
Hanada
Keiji
K
Ikeda
Seiyo
S
Igarashi
Yoshinori
Y
Itoi
Takao
T
Kida
Mitsuhiro
M
Honda
Goro
G
Sai
Jinkan
J
Horaguchi
Jun
J
Takahashi
Kuniyuki
K
Sasaki
Takamitsu
T
Takuma
Kensuke
K
Itokawa
Fumihide
F
Ando
Hisami
H
Takehara
Hiroo
H
D000681:Amylases / Q000032:analysis; D001646:Bile / Q000201:enzymology; D001655:Bile Reflux / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000002:abnormalities*; D003937:Diagnosis, Differential; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D010183:Pancreatic Ducts / Q000002:abnormalities*; D012372:ROC Curve; D012307:Risk Factors
D000681:Amylases