담췌관 합류이상의 임상적 고찰

Abstract

Background/Aims: Anomalous pancreaticobiliary ductal union (APBDU) is uncommon anomaly of the pancreaticobiliary ductal union system. Usually, the anomaly is confirmed by abnomally long common channel (>15 mm) by ERCP and is divided into two types according to relationship between pancreatic duct and common bile duct. Recently several reports showed that the APBDU may be associated with congenital choledochal cyst and gallbladder carcinoma. The purpose of this study is to evaluate clinical significance of APBDU, Methods: During the last 24 years, we experienced 45 cases of APBDU among the 8,951 ERCP cases and analyzed its clinical characteristics including the relationship between this anomaly and pancreaticobiliary diseases. Results: The mean age of the 45 cases was 45.9 years. The overall incidence of APBDU was 0.50% (45/8,951), but during the recent 5 years, a period of which the concept of APBDU has been generalized, the incidence of this anomaly has been 0.85% (39/4,607). Such difference may be the result of vigorous research. The type 1 APBDU was shown in 16 cases (36%) and type 2 was in 29 cases (64%), The average length of common channel was 21 mm and no statistical difference was noted between type 1 and 2 APBDU. The combined diseases were choledochal cysts in 24 cases (53%), gallstone disease in 13 cases (29%), gallbladder cancer in 10 cases (22%) and others in 3 cases (6.7%). The incidences of choledochal cyst and gallbladder cancer without APBDU were 0.6% (57/8,906) and 0.9% (79/ 8,906), respectively. Conclusions: The incidence of the APBDU was 0.85% among ERCP cases of which mean length of common channel is 21 mm. These results indicate that the APBDU is no more a rare conditon as we have thought. The incidence rates of type 1 and type 2 APBDU were 36% and 64%, respectively. The cases with APBDU was more closely associated with choledochal cyst and GB cancer than cases without APBDU.