Early Detection of Anomalous Arrangement of the Pancreaticobiliary Ductal System by Conventional US

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PurposeThough anomalous arrangement of the pancreaticobiliary ductal system (AAPBDS) is a very rare condition, biliary cancer develops frequently in patients with AAPBDS. So, it is very important to screen AAPBDS patients using an easy and noninvasive method. We focused on the thickening of the gallbladder wall often found ultrasonographically in patients with AAPBDS.Material & MethodsWe compared the thickness of the gallbladder wall measured before breakfast ultrasonographically using 3.5MHz probe between 15 patients with AAPBDS and 100 controls. Histological differences of the gallbladder wall of 13 patients with AAPBDS and 16 controls were examined.ResultsIn conventional ultrasonograph (US), thickened gall bladder wall (≥3mm) was observed in 87% of patients with AAPBDS (13 of 15), but only in 4% of controls (4 of 100) (P < 0.001). Histological examination revealed that the gallbladder mucosa was thicker in patients with AAPBDS than in controls (1.13±0.35mm vs 0.56±0.14mm, P < 0.001). Hyperplastic mucosa of the gallbladder was characteristic and the cause of wall thickening in patients with AAPBDS, but that change was not recognized in controls. No difference was seen in muscle layer between the two groups.ConclusionThickened gall bladder wall of unknown cause found by ultrasonography may be a clue to detect AAPBDS which is normally accompanied by hyperplastic thickened gallbladder mucosa. PurposeThough anomalous arrangement of the pancreaticobiliary ductal system (AAPBDS) is a very rare condition, biliary cancer develops frequently in patients with AAPBDS. So, it is very important to screen AAPBDS patients using an easy and noninvasive method. We focused on the thickening of the gallbladder wall often found ultrasonographically in patients with AAPBDS. Though anomalous arrangement of the pancreaticobiliary ductal system (AAPBDS) is a very rare condition, biliary cancer develops frequently in patients with AAPBDS. So, it is very important to screen AAPBDS patients using an easy and noninvasive method. We focused on the thickening of the gallbladder wall often found ultrasonographically in patients with AAPBDS. Material & MethodsWe compared the thickness of the gallbladder wall measured before breakfast ultrasonographically using 3.5MHz probe between 15 patients with AAPBDS and 100 controls. Histological differences of the gallbladder wall of 13 patients with AAPBDS and 16 controls were examined. We compared the thickness of the gallbladder wall measured before breakfast ultrasonographically using 3.5MHz probe between 15 patients with AAPBDS and 100 controls. Histological differences of the gallbladder wall of 13 patients with AAPBDS and 16 controls were examined. ResultsIn conventional ultrasonograph (US), thickened gall bladder wall (≥3mm) was observed in 87% of patients with AAPBDS (13 of 15), but only in 4% of controls (4 of 100) (P < 0.001). Histological examination revealed that the gallbladder mucosa was thicker in patients with AAPBDS than in controls (1.13±0.35mm vs 0.56±0.14mm, P < 0.001). Hyperplastic mucosa of the gallbladder was characteristic and the cause of wall thickening in patients with AAPBDS, but that change was not recognized in controls. No difference was seen in muscle layer between the two groups. In conventional ultrasonograph (US), thickened gall bladder wall (≥3mm) was observed in 87% of patients with AAPBDS (13 of 15), but only in 4% of controls (4 of 100) (P < 0.001). Histological examination revealed that the gallbladder mucosa was thicker in patients with AAPBDS than in controls (1.13±0.35mm vs 0.56±0.14mm, P < 0.001). Hyperplastic mucosa of the gallbladder was characteristic and the cause of wall thickening in patients with AAPBDS, but that change was not recognized in controls. No difference was seen in muscle layer between the two groups. ConclusionThickened gall bladder wall of unknown cause found by ultrasonography may be a clue to detect AAPBDS which is normally accompanied by hyperplastic thickened gallbladder mucosa. Thickened gall bladder wall of unknown cause found by ultrasonography may be a clue to detect AAPBDS which is normally accompanied by hyperplastic thickened gallbladder mucosa.