Endoscopic diagnosis and treatment of anomalous pancreaticobiliary ductal junction

Abstract

Objective To evaluate application of endoscopic retrograde cholangiopancreatography （ERCP） in diagnosis and managements of anomalous pancreaticobiliary ductal junction （APBDJ）. Methods Data of APBDJ patients, including oecurence, sub-type characteristics, relationship with concurrent pancreaticobiliary diseases and endoscopic treatment, who underwent ERCP in the past 5 years, were retrospectively reviewed. Results APBDJ was diagnosed in 49 patients, which accounted for 0. 74% of all ERCP cases （6639） in the same period, among whom, there were 27 cases of P-B sub-type, 19 B-P type, and 3 complex type. Gallbladder carcinoma was accompanied in 16 patients, choledochal cyst in 19, chronic pan creatitis in 7, and pancreas divisum in 2, with morbidity rates significantly higher than those in non-APBDJ population （P 〈 0. 01 ）. The gallbladder carcinoma was most commonly seen in P-B patients （14/16）, and choledochal cyst most frequently occurred in B-P type （15/19）. The endoscopic managements applied in APBDJ patients included sphincterotomy in 10 cases, naso-biliary drainage in 16, plastic stenting in 15, metal stenting in 6, and pancreatic stent placement in 2. Conclusion ERCP is a direct and reliable method for the diagnosis of APBDJ, which is commonly complicated with gallbladder carcinoma, choledochal cyst, and chronic pancreatitis. Endoscopic therapy can be considered in accordance with complications. Key words: Cholangiopancreatography, endoscopic retrograde ; Diagnosis ; Therapy ; Anomalous pancreaticobiliary ductal junction