title: Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults.
abstract: OBJECTIVE
  The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy.
  
  
  METHODS
  Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia.
  
  
  RESULTS
  Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 ± 33,592.43 IU/L; group B, 13.06 ± 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024).
  
  
  CONCLUSIONS
  Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.
authors: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors: Sung-Pil
authors: SP
authors: Yun
authors: Jee Yeon
authors: JY
authors: Lee
authors: Hong Jae
authors: HJ
authors: Jo
authors: Hyun Sung
authors: HS
authors: Kim
authors: Dae Hwan
authors: DH
authors: Kim
authors: Jae Hun
authors: JH
authors: Kim
authors: Sung Jin
authors: SJ
authors: Park
authors: Do Yoon
authors: DY
authors: Park
authors: Hyung-Il
authors: HI
authors: Seo
keywords: Amylase; Dysplasia; Ki-67 antigen; Pancreaticobiliary reflux
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