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Acute pancreatitis and a long common channel
Terumi Kamisawa1, Yuyang Tu, Hitoshi Nakajima
1Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Tokyo, 113-8677, Japan. kamisawa@cick.jp
Abdominal Imaging
|September 7, 2006
Summary
Acute pancreatitis is linked to long common channels in pancreaticobiliary maljunction (PBM). Obstruction or reflux within these channels can trigger pancreatitis, affecting 13% of patients.
Area of Science:
- Gastroenterology
- Hepatology
- Pancreatology
Background:
- Pancreaticobiliary maljunction (PBM) is characterized by a lack of functional sphincter control, leading to bidirectional regurgitation.
- A long common channel is a key feature in PBM, allowing communication between the pancreatic and bile ducts even with sphincter contraction.
Purpose of the Study:
- To investigate the characteristics of acute pancreatitis in patients with a long common channel.
- To determine the incidence and potential causes of acute pancreatitis in patients diagnosed with PBM and high confluence of pancreaticobiliary ducts (HCPBD).
Main Methods:
- A retrospective review of 3210 endoscopic retrograde cholangiopancreatograms was conducted.
- Patients were diagnosed with PBM if a long common channel maintained ductal communication during sphincter contraction.
- HCPBD was diagnosed in patients with a common channel ≥6 mm that occluded communication upon sphincter contraction.
Main Results:
- Four out of 107 PBM patients (approximately 3.7%) developed acute pancreatitis, with two cases suspected to be caused by impaction within the long common channel.
- Seventeen out of 60 HCPBD patients (approximately 28.3%) developed acute pancreatitis.
- Causes of pancreatitis in HCPBD patients included excessive alcohol intake (3), choledocholithiasis or cholecystitis (10), and other factors (4).
Conclusions:
- Acute pancreatitis affects approximately 13% of patients with a long common channel.
- Obstruction of the long common channel by gallstones can facilitate bile reflux into the pancreatic duct, inducing pancreatitis.
- Even without obstruction, biliopancreatic reflux in patients with a long common channel can lead to acute pancreatitis.
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