| Theme |
Up‒to‒date of the Protection of Gastroenterological Cancers |
| Title |
Pancreaticobiliary Maljunction and Biliary Cancer |
| Author |
Terumi Kamisawa |
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospita |
| Author |
Sawako Kuruma |
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospita |
| Author |
Kazuro Chiba |
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospita |
| Author |
Satomi Koizumi |
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospita |
| Author |
Masanao Kurata |
Department of Surgery, Tokyo Metropolitan Komagome Hospita |
| Author |
Goro Honda |
Department of Surgery, Tokyo Metropolitan Komagome Hospita |
| [ Summary ] |
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. In PBM, the common channel is so long that sphincter action does not affect the pancreaticobiliary junction, and pancreatic juice frequently refluxes into the biliary tract. Persistence of refluxed pancreatic juice injures the epithelium of the biliary tract and promotes cancer development, resulting in higher rates of carcinogenesis in the biliary tract. In a nationwide survey, biliary cancer was detected in 21.6 % of adult patients with congenital biliary dilatation (bile duct cancer : 32.1 % vs. gallbladder cancer : 62.3 %) and in 42.4 % of PBM patients without biliary dilatation (bile duct cancer : 7.3 % vs. gallbladder cancer：88.1 %). Once the diagnosis of PBM is established, immediate prophylactic surgery is recommended. However, the surgical strategy for PBM without biliary dilatation remains controversial. To allow early detection of PBM without biliary dilatation, magnetic resonance cholangiopancreatography is recommended for patients showing gallbladder wall thickening by screening ultrasound. |