Diagnosis and endoscopic therapy of pancreaticobiliary maljunction: MDT discussion_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Hai , ZHANG Changyun , LI Hong ,  YU Hao , ZHANG Fengshen

Department of General Surgery, Zunyi Fifth People’s Hospital, Zunyi, Guizhou 563000, P. R. China;

Corresponding author：

YU Hao, Email: 653503011@qq.com

Keywords：

multidisciplinary team; pancreaticobiliary maljunction; high confluence of pancreaticobiliary ducts; endoscopic sphincterotomy

DOI：

10.7507/1007-9424.201912105

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To discuss the diagnosis and endoscopic therapy of pancreaticobiliary maljunction by multidisciplinary team (MDT).Method The preoperative MDT discussion and the diagnosis and treatment process of patient with pancreaticobiliary maljunction in the Fifth People’s Hospital of Zunyi in 2019 were summarized.Results The patient was admitted for “upper abdominal pain approximately 10 h”. The obvious extramural confluence of the pancreaticobiliary tract was observed and the length of common channel was approximately 1.8 cm. But the junction of the pancreaticobiliary tract was obviously controlled by the sphincter of Oddi, and the amylase value of the bile was higher than that of the serum. After the MDT discussion, there were still doubts about the diagnosis of pancreaticobiliary maljunction or high confluence of pancreaticobiliary ducts. After the left hepatic lateral lobectomy and exploration of common bile duct, the amylase value of bile, which was collected by the T-tube, was still obviously increased. Then the endoscopic sphincterotomy was performed, the amylase value of the bile decreased obviously and no abnormality was found in the follow-up for half a year after discharge.Conclusions Concept and diagnostic criteria of “Japanese clinical practice guidelines for pancreaticobiliary maljunction” are conflicting and inaccurate. Severity of pancreaticobiliary reflux and change of amylase value of bile might have a more important diagnostic value. Endoscopic sphincterotomy might be suitable for a few special types of pancreaticobiliary maljunction.

Citation： SUN Hai, ZHANG Changyun, LI Hong, YU Hao, ZHANG Fengshen. Diagnosis and endoscopic therapy of pancreaticobiliary maljunction: MDT discussion. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 867-872. doi: 10.7507/1007-9424.201912105 Copy

1.	Kamisawa T, Kuruma S, Chiba K, et al. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol, 2017, 52(2): 158-163.
2.	Huh CW, Kim HW, Yi SW, et al. Common bile duct stones associated with pancreatobiliary reflux and disproportionate bile duct dilatation. Medicine (Baltimore), 2017, 96(34): e7701.
3.	Kamisawa T, Honda G. Pancreaticobiliary maljunction: markedly high risk for biliary cancer. Digestion, 2019, 99(2): 123-125.
4.	Kamisawa T, Ando H, Suyama M, et al. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol, 2012, 47(7): 731-759.
5.	Kamisawa T, Takuma K, Anjiki H, et al. Pancreaticobiliary maljunction. Clin Gastroenterol Hepatol, 2009, 7(11 Suppl): S84-S88.
6.	杨亚兵, 王玲, 曹迁, 等. 肝内胆管结石罹患胆管癌的预后因素分析. 中国微创外科杂志, 2018, 18(5): 385-400.
7.	Horaguchi J, Fujita N, Noda Y, et al. Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement. J Gastroenterol, 2008, 43(4): 305-311.
8.	Kozumi I, Kodama T. A case report and the etiology of choledochal cystic dilatation (in Japanese). J Tokyo Med Assoc, 1916, 30: 1413-1423.
9.	Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris), 1969, 12(3): 231-240.
10.	The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM). The Committee of JSPBM for Diagnostic Criteria. Diagnostic criteria of pancreaticobiliary maljunction. J Heptobiliary Pancreat Surg, 1994, 1: 219-221.
11.	Kamisawa T, Ando H, Hamada Y, et al. Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepatobiliary Pancreat Sci, 2014, 21(3): 159-161.
12.	Kamisawa T, Amemiya K, Tu Y, et al. Clinical significance of a long common channel. Pancreatology, 2002, 2(2): 122-128.
13.	Kamisawa T, Funata N, Hayashi Y, et al. Pathologic changes in the non-carcinomatous epithelium of the gallbladder in patients with a relatively long common channel. Gastrointest Endosc, 2004, 60(1): 56-60.
14.	Kamisawa T, Kuwata G, Yui CP, et al. Lesions with a high risk of carcinogenesis in the gallbladder of patients with a long common channel. Dig Endosc, 2006, 18(3): 192-195.
15.	Kamisawa T, Kuruma S, Tabata T, et al. Pancreaticobiliary maljunction and biliary cancer. J Gastroenterol, 2015, 50(3): 273-279.
16.	Sai JK, Suyama M, Kubokawa Y, et al. Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction. Gastrointest Endosc, 2003, 57(3): 364-368.
17.	Sugiyama M, Atomi Y. Pancreatic juice can reflux into the bile duct in patients without anomalous pancreaticobiliary junction. J Gastroenterol, 2004, 39(10): 1021-1022.
18.	Kamisawa T, Okamoto A. Biliopancreatic and pancreatobiliary refluxes in cases with and without pancreaticobiliary maljunction: diagnosis and clinical implications. Digestion, 2006, 73(4): 228-236.
19.	Matsumoto Y, Fujii H, Itakura J, et al. Recent advances in pancreaticobiliary maljunction. J Hepato-Biliary-Pancreatic Surg, 2002, 9(1): 45-54.
20.	Ng WD, Liu K, Wong MK, et al. Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: a preliminary report. Br J Surg, 1992, 79(6): 550-552.
21.	Samavedy R, Sherman S, Lehman GA. Endoscopic therapy in anomalous pancreatobiliary duct junction. Gastrointest Endosc, 1999, 50(5): 623-627.
22.	Jin Z, Bie LK, Tang YP, et al. Endoscopic therapy for patients with pancreaticobiliary maljunction: a follow-up study. Oncotarget, 2017, 8(27): 44860-44869.
23.	王晓瑾, 龚彪, 别里克·扣肯, 等. 内镜下胰胆管造影术对胆胰管汇合异常的诊断及治疗价值. 内科理论与实践, 2016, 11(1): 38-41.
24.	刘源, 刘金钢. 成人先天性胆管扩张症诊治进展. 中国普外基础与临床杂, 2014, 21(10): 1316-1320.
25.	Kikuyama M, Kamisawa T, Kuruma S, et al. A case of pancreaticobiliary maljunction with a connecting duct without a long common channel. Clin J Gastroenterol, 2017, 10(2): 196-199.

1. Kamisawa T, Kuruma S, Chiba K, et al. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol, 2017, 52(2): 158-163.
2. Huh CW, Kim HW, Yi SW, et al. Common bile duct stones associated with pancreatobiliary reflux and disproportionate bile duct dilatation. Medicine (Baltimore), 2017, 96(34): e7701.
3. Kamisawa T, Honda G. Pancreaticobiliary maljunction: markedly high risk for biliary cancer. Digestion, 2019, 99(2): 123-125.
4. Kamisawa T, Ando H, Suyama M, et al. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol, 2012, 47(7): 731-759.
5. Kamisawa T, Takuma K, Anjiki H, et al. Pancreaticobiliary maljunction. Clin Gastroenterol Hepatol, 2009, 7(11 Suppl): S84-S88.
6. 杨亚兵, 王玲, 曹迁, 等. 肝内胆管结石罹患胆管癌的预后因素分析. 中国微创外科杂志, 2018, 18(5): 385-400.
7. Horaguchi J, Fujita N, Noda Y, et al. Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement. J Gastroenterol, 2008, 43(4): 305-311.
8. Kozumi I, Kodama T. A case report and the etiology of choledochal cystic dilatation (in Japanese). J Tokyo Med Assoc, 1916, 30: 1413-1423.
9. Babbitt DP. Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris), 1969, 12(3): 231-240.
10. The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM). The Committee of JSPBM for Diagnostic Criteria. Diagnostic criteria of pancreaticobiliary maljunction. J Heptobiliary Pancreat Surg, 1994, 1: 219-221.
11. Kamisawa T, Ando H, Hamada Y, et al. Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepatobiliary Pancreat Sci, 2014, 21(3): 159-161.
12. Kamisawa T, Amemiya K, Tu Y, et al. Clinical significance of a long common channel. Pancreatology, 2002, 2(2): 122-128.
13. Kamisawa T, Funata N, Hayashi Y, et al. Pathologic changes in the non-carcinomatous epithelium of the gallbladder in patients with a relatively long common channel. Gastrointest Endosc, 2004, 60(1): 56-60.
14. Kamisawa T, Kuwata G, Yui CP, et al. Lesions with a high risk of carcinogenesis in the gallbladder of patients with a long common channel. Dig Endosc, 2006, 18(3): 192-195.
15. Kamisawa T, Kuruma S, Tabata T, et al. Pancreaticobiliary maljunction and biliary cancer. J Gastroenterol, 2015, 50(3): 273-279.
16. Sai JK, Suyama M, Kubokawa Y, et al. Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction. Gastrointest Endosc, 2003, 57(3): 364-368.
17. Sugiyama M, Atomi Y. Pancreatic juice can reflux into the bile duct in patients without anomalous pancreaticobiliary junction. J Gastroenterol, 2004, 39(10): 1021-1022.
18. Kamisawa T, Okamoto A. Biliopancreatic and pancreatobiliary refluxes in cases with and without pancreaticobiliary maljunction: diagnosis and clinical implications. Digestion, 2006, 73(4): 228-236.
19. Matsumoto Y, Fujii H, Itakura J, et al. Recent advances in pancreaticobiliary maljunction. J Hepato-Biliary-Pancreatic Surg, 2002, 9(1): 45-54.
20. Ng WD, Liu K, Wong MK, et al. Endoscopic sphincterotomy in young patients with choledochal dilatation and a long common channel: a preliminary report. Br J Surg, 1992, 79(6): 550-552.
21. Samavedy R, Sherman S, Lehman GA. Endoscopic therapy in anomalous pancreatobiliary duct junction. Gastrointest Endosc, 1999, 50(5): 623-627.
22. Jin Z, Bie LK, Tang YP, et al. Endoscopic therapy for patients with pancreaticobiliary maljunction: a follow-up study. Oncotarget, 2017, 8(27): 44860-44869.
23. 王晓瑾, 龚彪, 别里克·扣肯, 等. 内镜下胰胆管造影术对胆胰管汇合异常的诊断及治疗价值. 内科理论与实践, 2016, 11(1): 38-41.
24. 刘源, 刘金钢. 成人先天性胆管扩张症诊治进展. 中国普外基础与临床杂, 2014, 21(10): 1316-1320.
25. Kikuyama M, Kamisawa T, Kuruma S, et al. A case of pancreaticobiliary maljunction with a connecting duct without a long common channel. Clin J Gastroenterol, 2017, 10(2): 196-199.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and endoscopic therapy of pancreaticobiliary maljunction: MDT discussion

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