Abstract
Pancreaticobiliary maljunction (PBM) describes both cases in which the extrahepatic bile duct is dilated (PBM with biliary dilatation, congenital biliary dilatation) and those in which it is not dilated (PBM without biliary dilatation). A recent detailed report of extrahepatic bile duct measurements using ultrasonography has largely defined a non-dilated bile duct. According to the report, the maximum inner diameter of an extrahepatic bile duct increases according to age. Once the diagnosis of PBM is established, immediate prophylactic surgical treatment is recommended before the onset of malignant changes, even in patients without biliary dilatation. Cholecystectomy and resection of the extrahepatic bile duct, so-called flow-diversion surgery, are established standard surgical methods for PBM with biliary dilatation. As a therapeutic strategy for PBM without biliary dilatation, prophylactic cholecystectomy is also strongly recommended as standard surgical treatment for prevention of gallbladder cancer. However, whether additional prophylactic resection of the extrahepatic bile duct, as in flow-diversion surgery, should be performed for PBM without biliary dilatation remains controversial. Further investigation and surveillance are needed to clarify the appropriate surgical strategy for PBM without biliary dilatation.
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References
Takuma K, Kamisawa T, Tabata T, Hara S, Kuruma S, Inaba Y, et al. Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation. World J Gastroenterol. 2012;18:3409–14.
Kamisawa T, Ando H, Hamada Y, Fujii H, Koshinaga T, Urushihara N, et al. Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepatobiliary Pancreat Sci. 2014;21:159–61.
Itoi T, Kamisawa T, Fujii H, Inui K, Maguchi H, Hamada Y, et al. Extrahepatic bile duct measurement by using transabdominal ultrasound in Japanese adults: multi-center prospective study. J Gastroenterol. 2013;48:1045–50.
Kamisawa T, Kuruma S, Chiba K, Tabata T, Koizumi S, Kikuyama M. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol. 2017;52:158–63.
Morine Y, Shimada M, Takamatsu H, Araida T, Endo I, Kubota M, et al. Clinical features of Pancreaticobiliary Maljunction: update analysis of 2nd Japan-nationwide survey. J Hepatobiliary Pancreat Sci. 2013;20:472–80.
Noda Y, Fujita N, Kobayashi G, Ito K, Horaguchi J, Takasawa O, et al. Histological study of gallbladder and bile duct epithelia in patients with anomalous arrangement of the pancreaticobiliary ductal system: comparison between those with and without a dilated common bile duct. J Gastroenterol. 2007;42:211–8.
Masuhara S, Kasuya K, Aoki T, Yoshimatsu A, Tsuchida A, Koyanagi Y. Relation between K-ras codon 12 mutation and p53 protein overexpression in gallbladder cancer and biliary ductal epithelia in patients with pancreaticobiliary maljunction. J Hepato-Biliary-Pancreat Surg. 2000;7:198–205.
Deng YL, Cheng NS, Lin YX, Zhou RX, Yang C, Jin YW, et al. Relationship between pancreaticobiliary maljunction and gallbladder carcinoma: meta-analysis. Hepatobiliary Pancreat Dis Int. 2011;10:570–80.
Kusano T, Takano T, Tachibana K, Tanaka Y, Kamachi M, Ikematsu Y, et al. Whether or not prophylactic excision of the extrahepatic bile duct is appropriate for patients with pancreaticobiliary maljunction without bile duct dilatation. Hepato-Gastroenterology. 2005;52:1649–53.
Ohuchida J, Chijiiwa K, Hiyoshi M, Kobayashi K, Konomi H, Tanaka M. Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation. Arch Surg. 2006;141:1066–70.
Funabiki T, Matsubara T, Miyakawa S, Ishihara S. Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbeck's Arch Surg. 2009;394:159–69.
Seki M, Yanagisawa A, Ninomiya E, Ninomiya Y, Ohta H, Saiura A, et al. Clinicopathology of pancreaticobiliary maljunction: relationship between alterations in background biliary epithelium and neoplastic development. J Hepato-Biliary-Pancreat Surg. 2005;12:254–62.
Matsubara T, Sakurai Y, Zhi L, Miura H, Ochai M, Funabiki T. K- ras and p53 gene mutations in noncancerous biliary lesions of patients with pancreaticobiliary maljunction. J Hepato-Biliary-Pancreat Surg. 2002;9:312–21.
Yamada S, Shimada M, Utsunomiya T, Morine Y, Imura S, Ikemoto T, et al. Hilar cholangiocarcinoma accompanied by pancreaticobiliary maljunction without bile duct dilatation 20 years after cholecystectomy: report of a case. J Med Investig. 2013;60:169–73.
Ando H, Ito T, Nagaya M, Watanabe Y, Seo T, Kaneko K. Pancreaticobiliary maljunction without choledochal cysts in infants and children: clinical features and surgical therapy. J Pediatr Surg. 1995;30:1658–62.
Kamisawa T, Ando H, Suyama M, Shimada M, Morine Y, Shimada H. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol. 2012;47:731–59.
Miyazaki M, Yoshitomi H, Miyakawa S, Uesaka K, Unno M, Endo I, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. J Hepato-Biliary-Pancreat Surg. 2015;22:249–73.
Kamisawa T, Ando H, Shimada M, Hamada Y, Itoi T, Takayashiki T, et al. Recent advances and problems in the management of pancreaticobiliary maljunction: feedback from the guidelines committee. J Hepatobiliary Pancreat Sci. 2014;21:87–92.
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Takayashiki, T., Yoshitomi, H., Furukawa, K., Ohtsuka, M. (2018). Therapeutic Strategy for PBM Without Biliary Dilatation. In: Kamisawa, T., Ando, H. (eds) Pancreaticobiliary Maljunction and Congenital Biliary Dilatation. Springer, Singapore. https://doi.org/10.1007/978-981-10-8654-0_27
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DOI: https://doi.org/10.1007/978-981-10-8654-0_27
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