セッション情報 The 4th International Forum

II Challenge to the pancreatic and biliary cancers 4. Biliary cancer―Challenge to the better prognosis

タイトル IFII-4-3:

Pancreaticobiliary maljunction and biliary cancer

演者 Kamisawa Terumi(Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan)
共同演者 Tabata Taku(Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan), Kuruma Sawako(Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan)
抄録 Pancreaticobiliary maljunction(PBM)is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. PBM can be divided into congenital choledochal cyst and PBM without biliary dilatation. Since the action of the sphincter of Oddi does not functionally affect the junction of the pancreatic and bile ducts in PBM patients, continuous reciprocal reflux between pancreatic juice and bile occurs. Given that the hydropressure within the pancreatic duct is usually greater than that in the bile duct, pancreatic juice frequently refluxes into the biliary duct in PBM. Persistence of refluxed pancreatic juice injures the epithelium of the biliary tract and promotes cancer development. Biliary tract cancer is detected in 21.6% of patients with congenital biliary dilatation and in 42.4% of PBM patients without biliary dilatation. The main lesions in patients with congenital biliary dilatation are gallbladder cancer in 62.3% and bile duct cancer in 32.1%, and those in PBM patients without biliary dilatation are gallbladder cancer in 88.1%. The biliary tract of PBM patients can be considered to be a premalignant region.
PBM is diagnosed according to the diagnostic criteria for PBM 2013. For the diagnosis, an abnormally long common channel and/or an abnormal union between the pancreatic and bile ducts must be evident on direct cholangiography, such as ERCP, PTC, or intraoperative cholangiography;MRCP;or 3D-DIC. PBM can be diagnosed also by EUS or MPR images provided by MD-CT. Elevated amylase levels in bile and extrahepatic bile duct dilatation strongly suggest the existence of PBM.
Prophylactic flow-diversion surgery is performed for congenital biliary dilatation, and only prophylactic cholecystectomy is performed for PBM patients without biliary dilatation in many institutes.
It is important to detect PBM before the development of biliary cancer and perform a prophylactic surgery. To detect PBM without biliary dilatation early, performing MRCP is important for patients showing gallbladder wall thickening on screening US under suspicion of PBM.
索引用語