Risk factor for extrahepatic bile duct cancer in patients with anomalous pancreaticobiliary ductal union.

BACKGROUND/AIMS: Anomalous connection between the choledochus and pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cyst, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose was analysis of combined disease, especially biliary neoplasm and evaluated microscopic changes of extrahepatic bile ducts.

METHODOLOGY: To study the clinical characteristics of anomalous pancreaticobiliary ductal union (APBDU), we reviewed 14 APBDU cases from June 1994 to June 1998. We studied the associated disease, surgical treatment, and the histological findings of the extrahepatic bile ducts.

RESULTS: Gallbladder cancer was identified in 5 out of 14 patients with APBDU. The incidences of metaplasia of gallbladder and bile duct with APBDU were higher than that of control gallbladder epithelium. The proliferating cell nuclear antigen-labeling index of the gallbladder in patients with APBDU was significantly higher than that in the control group.

CONCLUSIONS: The patients with APBDU showed high incidence of gallbladder carcinoma and metaplasia in epithelium of gallbladder and bile duct. As this metaplasia in the gallbladder and bile duct is thought of as a precancerous condition, it is important to remove the place that causes bile stasis and to stop backflow of pancreatic juice into the bile duct in managing patients with this anomaly. In other words, prophylactic cholecystectomy and reconstruction of the biliary tract are both necessary.