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Classification of pancreaticobiliary maljunction and its clinical features in adults
Kensuke Yoshimoto1,2, Terumi Kamisawa1, Masataka Kikuyama1
1Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Insights
Pancreaticobiliary maljunction (PBM) classification differs in adults versus children. Adults with a cudgel-type Santorini duct showed no biliary carcinoma development, unlike other types.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Pancreaticobiliary maljunction (PBM) involves reflux of pancreatic juice and bile, causing biliary tract and pancreatic pathology.
- A 2015 classification system categorizes PBM based on distal bile duct and main pancreatic duct confluence.
Purpose of the Study:
- To evaluate clinical features and complicating diseases in adult PBM patients based on the 2015 classification.
- To assess Santorini duct patency and the incidence of biliary carcinomas in adult PBM patients.
Main Methods:
- Clinical data and complicating diseases were analyzed in 168 adult PBM patients.
- Santorini duct patency and biliary carcinomas were evaluated in 123 patients.
Main Results:
- Adult PBM classification showed significant differences in age and common bile duct type compared to children.
- Biliary carcinomas were frequent (87 cases), but absent in patients with a cudgel-type Santorini duct (>2 mm diameter).
- No significant difference in abdominal pain or hyperamylasemia incidence was observed between PBM classifications in adults.
Conclusions:
- Clinical features of PBM in adults differ from those in children based on the 2015 classification.
- Adult PBM patients frequently develop biliary carcinomas, but a cudgel-type Santorini duct appears protective against their development.
Background:
In pancreaticobiliary maljunction (PBM), reflux of pancreatic juice and bile produces various pathological conditions in the biliary tract and pancreas. Clinical features according to the classification of PBM by confluence between the distal bile duct and the main pancreatic duct proposed in 2015 were evaluated in children.
Methods:
Clinical features and complicating diseases according to the PBM classification were evaluated in 168 adult PBM patients. Patency of Santorini duct and associated biliary carcinomas were evaluated in 123 patients.
Results:
Similar to children, there were significant differences in age (P < 0.01) and type of common bile duct (P < 0.01) between the groups of the classification. Unlike in children, there was no significant difference in the incidence of abdominal pain and hyperamylasemia. There were 87 associated biliary carcinomas (79 gallbladder carcinomas and eight cholangiocarcinomas). PBM patients with a cudgel-type Santorini duct, which is greater than 2 mm in diameter, did not develop biliary carcinomas, compared to 61.1% of those with other types of Santorini duct (P < 0.01).
Conclusions:
Clinical features according to the PBM classification in adults were different from those in children. Although biliary carcinomas were frequently seen in adult PBM patients, none of those with a cudgel-type Santorini duct developed biliary carcinoma.
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