title: Pancreatobiliary reflux in individuals with a normal pancreaticobiliary junction: a prospective multicenter study.
abstract: BACKGROUND
  Pancreatobiliary reflux (PBR) can occur in individuals without pancreaticobiliary maljunction. The aim of this study was to elucidate the incidence of PBR in individuals with a normal pancreaticobiliary junction and its impact on the biliary tree.
  
  
  METHODS
  Data were prospectively collected from 15 centers on 420 patients with a morphologically normal pancreaticobiliary junction who had undergone bile sampling and measurement of the biliary amylase level. We investigated the incidence and predictive factors for high biliary amylase levels (HBAL), as well as the relationship of HBAL with biliary malignancy.
  
  
  RESULTS
  Twenty-three patients (5.5%) showed HBAL (≥10,000 IU/L). Univariate analysis showed that risk factors for the elevation of biliary amylase levels were the existence of a relatively long common channel (≥5 mm), acute pancreatitis, and papillitis. Multivariate analysis revealed that only the existence of a relatively long common channel was a significant factor for PBR. Biliary amylase levels in patients with a relatively long common channel were significantly higher than in patients without a long common channel (12,333 vs. 2,070 IU/L, P = 0.001). The incidence of HBAL (P < 0.001), as well as the overall biliary amylase levels (P = 0.007) were significantly higher in patients with gallbladder cancer than in those without gallbladder cancer.
  
  
  CONCLUSIONS
  The PBR was frequently observed in individuals with a relatively long common channel. Patients showing HBAL with normal pancreaticobiliary junction are at high risk for gallbladder cancer.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, Miyagi, 983-0824, Japan, j-hora@qg7.so-net.ne.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Horaguchi
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Inui
authors.forename: Keiji
authors.initials: K
authors.lastname: Hanada
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hamada
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Koshinaga
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Naoto
authors.initials: N
authors.lastname: Urushihara
authors.forename: Hisami
authors.initials: H
authors.lastname: Ando
mesh_terms: D000368:Aged; D000681:Amylases / Q000378:metabolism; D001646:Bile / Q000378:metabolism; D001652:Bile Ducts / Q000002:abnormalities / Q000033:anatomy & histology; D001655:Bile Reflux / Q000453:epidemiology / Q000503:physiopathology*; D003135:Common Bile Duct / Q000002:abnormalities; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000503:physiopathology*; D005706:Gallbladder Neoplasms / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010182:Pancreatic Diseases / Q000453:epidemiology / Q000503:physiopathology*; D010183:Pancreatic Ducts / Q000033:anatomy & histology; D011446:Prospective Studies
chemical_list: D000681:Amylases