Endoscopic diagnosis and therapy of anomalous pancreatico-biliary junction

R. Samavedy, S. Sherman, G. Lehman

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Abstract

Anomalous pancreaticobiliary duct junction (APBDJ) is defined as union of pancreatic and biliary ducts outside the duodenal wall. APBDJ is associated with bile duct strictures, pancreatitis, choledochal cysts and biliary carcinoma. Limited data are available in reference to endoscopic sphincterotomy to prevent bile reflux into the pancreas and thus to control pain or pancreatitis. METHODS: Review of the data log on 7327 ERCP patients from 1988-96 yielded 16 patients identified to have APBDJ. Their symptoms and therapeutic responses were tallied by chart reviews, phone calls or questionnaires. RESULTS: There were 11 females and 5 males, with a mean age of 34y (range 6y to 72y). These patients presented with pancreatitis (75%) and, pain and/or jaundice (25%). Review of the ERCPs showed biliary type union (n=10), pancreatic type union (n=3) and an indeterminate Y type (n=3). The mean length of the common channel was 19.7 mm (7 mm-37.4 nun) and the shape was tubular (n=11), saccular (n=2) and ovoid (n=3). Eleven patients had no ductographic evidence of pancreatitis and 5 had chronic pancreatitis. Seven patients had choledochal cysts. Thirteen patients (81.3%) underwent endoscopic biliary sphincterotomy (ES) two of whom underwent repeat ES for recurrence of symptoms. The other therapies included, biliary stenting of benign strictures in 3 patients, lithotripsy of pancreatic stones in 1 patient and choledochal cyst removal in 4 patients. Two cases with malignant biliary strictures (1 carcinoma of gallbladder, 1 metastatic colon cancer) are excluded from endoscopic outcome studies. The 12 patients with pancreatitis had a mean of 2.0 episodes per year prior to any treatment. After endoscopic therapy 7 patients had no further pancreatitis, 5 patients had further pancreatitis, with a mean of one additional attack per year, over 3 years mean follow up. The pain only group continued to have pain. SUMMARY: APBDJ patients have complex pathology associated with strictures, choledochal cysts and pancreatitis. Endoscopic therapy appeared to benefit 9 out of the 14 patients in this series, with elimination of pancreatitis or clinically judged significant decrease in pancreatitis frequency. Four patients required surgical intervention for cyst resection. CONCLUSION: 1. Larger series (presumably multicenter) are needed to better define the role of endoscopic management. There is a risk of biliary malignancy with this condition, requiring life-long close follow-up.

Original languageEnglish (US)
Pages (from-to)AB164
JournalGastrointestinal endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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