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Pancreaticobiliary Reflux with Normal and Relatively Long Common Channels Causing Cholelithiasis and Acute
Katsunori Kouchi1, Ayako Takenouchi2, Aki Matsuoka1
1Department of Pediatric Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
Insights
Pancreaticobiliary reflux (PBR) in children with normal or elongated common channels (CCs) can cause pancreatitis and gallstones. Early diagnosis via ERCP and bile analysis is key for effective treatment and symptom resolution.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Biliary System Pathophysiology
Background:
- Pancreaticobiliary maljunction (PBMJ) involves a long common channel (CC) leading to pancreaticobiliary reflux (PBR), linked to gallstones and cholangiocarcinoma.
- PBR can occur with normal or elongated CCs, a condition rarely reported in children.
- This study investigates PBR in children presenting with pancreatitis and cholelithiasis.
Purpose of the Study:
- To report the clinical characteristics and diagnostic findings of PBR in children with normal and relatively long CCs.
- To highlight the association between CC length, PBR, and gastrointestinal diseases in pediatric patients.
Main Methods:
- Seven children with refractory pancreatitis and cholelithiasis diagnosed with PBR were included.
- Endoscopic retrograde cholangiopancreatography (ERCP) and cholangiography were used to measure CC length and sphincter of Oddi.
- Bile amylase and lipase levels were analyzed.
Main Results:
- All seven children had elevated bile amylase and lipase levels.
- CC lengths ranged from 2.2-5.5 mm; two were normal, and five were elongated (0.3-1.1 mm longer than normal).
- All patients underwent successful surgical intervention (bile duct resection and anastomosis) with no recurrence.
Conclusions:
- Children with cholelithiasis and pancreatitis may have PBR due to normal or elongated CCs.
- ERCP, cholangiography focusing on CC length, and bile enzyme analysis are crucial for diagnosing PBR in pediatric patients.
- Surgical management offers a definitive solution for PBR-induced gastrointestinal diseases in children.
Abstract:
Background and Aims: Pancreaticobiliary maljunction (PBMJ) has a long common channel (CC) that causes pancreaticobiliary reflux (PBR), which has been implicated in gallstones, cholangiocarcinoma, and pancreatitis. By contrast, PBR has occurred in cases with normal and longer CCs than normal but shorter than PBMJ. This pathophysiology has been primarily reported in adults and rarely in children. We sometimes observe this pathophysiology in children with pancreatitis and cholelithiasis. Herein, we report the clinical figures on the diagnosis of children with PBR in normal and relatively long CCs. Patients and Methods: This study included seven children who complained of refractory pancreatitis and cholelithiasis diagnosed with PBR in normal and relatively long CCs at our institution from August 2018 to September 2024. We measured the lengths of their CCs and sphincter of Oddi muscles via endoscopic retrograde cholangiopancreatography (ERCP) and cholangiography. In addition, amylase and lipase levels in bile juice were measured. Results: All seven children demonstrated elevated amylase and lipase levels in bile juice obtained from gallbladder drainage and/or the common bile duct. ERCP and cholangiography indicated 2.2-5.5-mm lengths of CCs in their cases, which are normal lengths in two cases and relatively longer (0.3-1.1 mm: mean 0.6 mm) than the normal upper limit of CC in children in five cases, with their CCs shorter than the sphincters of Oddi. All children underwent extrahepatic bile duct resection and bilio-jejunal anastomosis, demonstrating no clinical symptom recurrence postoperatively. Conclusions: Some children with cholelithiasis and pancreatitis exhibit normal and relatively long CCs, causing PBR and inducing gastrointestinal diseases. Careful investigation by ERCP and cholangiography focused on the CC length, and pancreatic enzyme level assessments in bile juice are useful for diagnosing PBR in children with cholelithiasis and refractory pancreatitis.
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