[Carcinoma of the gallbladder in anomalous pancreaticoliliary ductal junction]

Anomalous pancreaticobiliary ductal junction (APBDJ) can be defined as the junction between the choledochus and the pancreatic duct outside of the duodenalwall and beyond the influence of the sphincter of Oddi. The frequency of APDBJ has been reported to be 2-3% of patients examined with ERCP. The significance of APBDJ has been recognized as an etiological factor developing congenital choledochal dilatation (CCD) and biliary tarct carcinoma because most patients with CCD present with APBDJ and 23% of patients with APBDJ have biliary tract carcinoma in the Japanese nationwide study. Of the patients with APBDJ, approximately 80% are associated with CCD and the remaining 20% are not. The occurrence rate of biliary tract carcinoma has been reported to be 3-18% (9% in ours) in the former group, while it reaches 33-54% or even more in the latter. The origin of biliary tract carcinoma is either the gallbladder or extrehepatic bile duct in most patients with CCD, whereas the gallbladder is in patients without CCD. We advocate the excision of the extrahepatic dilated bile duct together with the gallbladder in patients with CCD and cholecystectomy for patients with APBDJ without CCD at the time of diagnosis. The necessity of prophylatic hepatectomy in patients with type IVA CCD and of prophylactic resection of the extrahepatic bile duct in patients without CCD need further analyses to draw the final conclusion. Careful follow-up is recommended against the liver, biliary tract and pancreas even after surgery.