Pancreaticobiliary diseases associated with anomalous pancreaticobiliary ductal union

Anomalous pancreaticobiliary ductal union (APBDU) is associated with different pancreaticobiliary diseases. The aim of this study is to clarify the frequency with which it occurs and its several subtypes in various pancreaticobiliary diseases.

Radiograms of 1752 subjects who underwent endoscopic retrograde cholangiopancreatography were reviewed independently by two endoscopists. APBDU was diagnosed using recently accepted criteria and divided into B-P and P-B subtypes according to the insertion of biliary and pancreatic ducts.

Fifty-nine (8.7%) of 680 subjects with clearly visualized pancreaticobiliary radiograms had APBDU. APBDU was present in 93.8% of patients (15 of 16) with choledochal cyst, 62.5% (5 of 8) with gallbladder cancer, 33.3% (9 of 27) with common bile duct cancer, 50.0% (6 of 12) with gallbladder adenomyomatosis, 13.2% (7 of 53) with biliary pancreatitis, 3.4% (10 of 293) with cholelithiasis, 2.2% (2 of 89) with non-biliary pancreatitis, 2.1% (1 of 47) with hilar cholangiocarcinoma, 1.9% (1 of 54) with pancreatic cancer, and 10.2% (9 of 88) with other miscellaneous disorders. There were 25 patients (42.4%) with the B-P type and 34 patients (57.6%) with the P-B type of APBDU. Patients with choledochal cyst frequently had the B-P type, whereas gallbladder cancer, adenomyomatosis, or biliary pancreatitis frequently coexisted with the P-B type.

APBDU is relatively common in patients undergoing endoscopic retrograde cholangiopancreatography at our center. There are a variety of pancreaticobiliary diseases that are associated with APBDU. Its role in these conditions is uncertain and needs to be further delineated.