Gallbladder Carinoma Associated with Pancreatobiliary Reflux: A Hint for Early Diagnosis of Gallbladder Carcinoma

Abstract

Background: Pancreatobiliary reflux can occur in patients with and without pancreaticobiliary maljunction (PBM), and it may be associated with gallbladder carcinoma. One of the imaging findings that suggest mucosal changes accompanied by pancreatobiliary reflux is diffuse thickening of the hypoechoic inner layer of the gallbladder wall on abdominal ultrasonography that might reflect cellular proliferation of the gallbladder epithelium. The aim of the present study was to detect the patients with gallbladder carcinoma associated with pancreatobiliary reflux at an early stage by examining ultrasonography and bile sampling. Methods: From March 1995 to September 2007, among 186 patients, who had diffuse thickness (> 3mm) of the inner layer of the gallbladder wall and were suspected of having PBM on ultrasonography in our outpatient clinic, 95 patients were subjected to endoscopic retrograde cholangiopancreatography and bile in the common bile duct was sampled. Among them, patients, who had extremely high biliary amylase levels (> 10,000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients were examined. Results: Fifty-two patients had biliary amylase levels in the common bile duct above 10,000 IU/L, including 32 with PBM and 20 without PBM. The occurrence of gallbladder carcinoma and that limited within the mucosa was 31% (10/32), 13% (4/32) in patients with PBM, and 40% (8/20), 15% (3/20) in those without PBM. The occurrence of mucosal hyperplasia and dysplasia was 81% (26/32), 53% (17/32) in patients with PBM, and 85% (17/20), 65% (13/21) in those without PBM. Conclusion: Earlier detection of the diffuse thickening of the hypoechoic inner layer of the gallbladder wall associated with pancreatobiliary reflux could lead to earlier management of gallbladder carcinoma, and might improve the poor prognosis of this tumor.