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Common bile duct stones associated with pancreatobiliary reflux and disproportionate bile duct dilatation

 Cheal Wung Huh  ;  Hee Wook Kim  ;  Seung Woo Yi  ;  Dong Ki Lee  ;  Se Joon Lee 
 Medicine, Vol.96(34) : e7701, 2017 
Journal Title
Issue Date
Adult ; Aged ; Bile Acids and Salts/analysis ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Gallstones/epidemiology* ; Humans ; Male ; Middle Aged ; Pancreatic Diseases/epidemiology* ; Pancreatic Diseases/pathology* ; Pancreatic Ducts/pathology* ; Retrospective Studies
bile duct dilatation ; bile duct stones ; pancreatobiliary reflux
Occult pancreatobiliary reflux (PBR) in patients with a normal pancreatobiliary junction has been studied by various methods, but the exact etiology, mechanisms, and implications of this reflux have not yet been clarified. The aim of this study was to investigate the degree of PBR and patterns of biliary ductal dilatation in patients with acute calculous cholangitis by endoscopic retrograde cholangiopancreatography (ERCP).We retrospectively evaluated the degree of PBR and pattern of bile duct dilatation in patients with acute calculous cholangitis due to distal CBD (common bile duct) stones (Group A) as compared with patients with malignant CBD obstruction due to distal CBD cancer (Group B). All related data were prospectively collected. Bile juice was aspirated at the proximal CBD for measurement of biliary amylase and lipase before the injection of contrast dye. The diameters of the CBD and the peripheral intrahepatic duct (IHD) were calculated after contrast dye injection. Patients with pancreatobiliary maljunction and/or gallstone pancreatitis were excluded from the study.ERCP was performed on 33 patients with calculous cholangitis (Group A) and 12 patients with malignant CBD obstruction (Group B). Mean levels of bile amylase and lipase were significantly higher (P < .05) in group A (1387 and 6737 U/l, respectively) versus those in group B (32 and 138 U/l, respectively). Thirty patients in group A (90.9%) showed disproportionate dilatation (i.e., CBD was and IHD was not dilated), whereas only 4 patients in group B (33%) showed disproportionate dilatation.The results of this study suggest that patients with calculous cholangitis exhibit PBR that is associated with disproportionate bile duct dilatation.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
이동기(Lee, Dong Ki) ORCID logo https://orcid.org/0000-0002-0048-9112
이세준(Lee, Se Joon) ORCID logo https://orcid.org/0000-0002-2695-2670
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