Common Bile-Duct Mucosa in Choledochoduodenostomy Patients — Histological and Histochemical Study

E Eleftheriadis,V Tzioufa,H Aletras,K Kotzampassi

doi:10.1155/1988/85102

Abstract

We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1–12 years after choledochoduodenal anastomosis. Our findings — hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins — express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients.

Highlights

After choledochoduodenal anastomosis (CDA), the common bile-duct mucosa (CBDM) is exposed to a different environment, no longer being protected by the sphincter of Oddi
Small mucous glands are present in the lamina propria, their cell secreting predominantly acid-sulfated mucins, but some secreting neutral and acid sialomucins
Occasional metaplastic goblet cells not normally found in the CBDM were observed, as well as pyloric-like glands

Summary

Introduction

After choledochoduodenal anastomosis (CDA), the common bile-duct mucosa (CBDM) is exposed to a different environment, no longer being protected by the sphincter of Oddi. Theoretically, this new environment i.e. gastric acid and food flowing through the anastomosis- should affect it, both clinical practice and experimental data have shown no evidence of disturbance when no stenosis or occlusion is present; in other words, the CBDM "adapts". There has been real progress in the understanding of both the meaning and the mechanisms of adaption, through study of the mucosal morphology and cell kinetics of the small intestine, which represents the most intimate interface between the milieux exterieur and interiur, and exhibits a remarkable capacity to adapt to environmental changes.

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Conclusion