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Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC)

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Abstract

Background

Pancreaticobiliary maljunctions (PBMs) are congenital anomalies of the junction between pancreatic and bile ducts, frequently associated with bile duct cyst (BDC). BDC is congenital biliary tree diseases that are characterized by distinctive dilatation types of the extra- and/or intrahepatic bile ducts. Todani’s types I and IVa, in which dilatation involves principally the main bile duct, are the most frequent. PBM induces pancreatic juice reflux into the biliary tract that is supposed to be one of the main factors of biliary cancer degeneration, although the diagnostic criteria of PBM that can be either morphological and/or functional are not well defined especially in Western series.

Objective

The aim of this study was to assess the relative prevalence of PBM in BDC in a large European multicenter study, to analyze the characteristics of PBM and try to propose diagnostic criteria of PBMs based on morphological and/or functional criteria and define the positive, negative predictive values, sensibility and specificity of either criteria.

Results

From 1975 to 2012, 263 patients with BDC were analyzed. Among them, 190 (72.2 %) were considered to present PBM. Types I and IVa had a similar rate of PBM association. According to the “AFC classification,” 57.2 % had a C–P type, 34.5 % a P–C type and 8.3 % a complex type (“anse-de-seau”). The median length of the common channel in patients with PBM was 15.8 ± 6.8 mm (range 5–40 mm). The median intrabiliary amylase and lipase levels were 65,249 and 172,104 UI/L, respectively. For the diagnostic of PBM, a common channel length of more than 8 mm and an intrabiliary amylase level superior to 8000 UI/L were associated with a predictive positive value and a specificity of more than 90 %. Synchronous biliary cancer had an incidence of 8.7 % in all patients with BDC and PBM 11.1 % in adults. Compared to type IV, the type I BDC was associated with statistically more cancer patients in the presence of PBM.

Conclusions

Characteristics of PBM associated with BDC in Western population are quite close to reported Eastern series. The results suggest considering both the intrabiliary value of amylase >8000 UI/L and a length of a common channel >8 mm as appropriate values for positive diagnosis of PBM.

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Abbreviations

AFC:

Association Française de Chirurgie

ASA:

American Society of Anesthesiologists

BDC:

Bile duct cyst

C–P:

Choledochal to pancreatic

ERCP:

Endoscopic retrograde cholangiopancreatography

HBP:

Hepato-biliary and pancreatic

MRCP:

Magnetic resonance cholangiopancreatography

NPV:

Negative predictive value

P–C:

Pancreatic to choledochal

PBJ:

Pancreaticobiliary junction

PBM:

Pancreaticobiliary maljunctions

PPV:

Positive predictive value

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Acknowledgments

The authors would like to thank Adham Mustapha—Hôpital Edouard Herriot, Lyon, France; Doussot Alexandre—Hôpital Universitaire Dijon, France; Branchereau Sophie—Hôpital Universitaire de Necker, Paris, France; Ayav Ahmet—Hôpital Universitaire de Nancy, France; Balladur Pierre—Hôpital Saint Antoine, Paris, France; Adam René, Paul Brousse—CHB, Villejuif, France; Troisi Roberto I.-University Hospital Gent, Gent, Belgium; Regimbeau Jean Marc-Amiens—Hôpital Universitaire d’Amiens, France; Majno Pietro—Hôpital Universitaire de Genève, Geneva, Switzerland; Sommacale Daniele—Hôpital Universitaire Robert Debré, Reims, France; Bouzid Chafik—Pierre et Marie Curie Hospital, Alger, Algeria; and Falconi Massimo—Verona hospital, Verona, Italy.

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Authors and Affiliations

  1. Department of HPB Surgery, Hôpital Beaujon, Clichy, France

    Emilia Ragot, Alain Sauvanet & Safi Dokmak

  2. Department of Digestive Surgery and Hepatic Transplantation, Hôpital de la Croix-Rousse, Lyon, France

    Jean-Yves Mabrut

  3. Department of Digestive and Oncological Surgery, Hôpital Timone, Marseille, France

    Mehdi Ouaïssi

  4. Department of HPB Surgery, Hôpital Gemelli, Rome, Italy

    Gennaro Nuzzo

  5. Department of Digestive Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Nermin Halkic

  6. Department of Pediatric Surgery, Hôpital Femme-Mère-Enfant, Lyon, France

    Remi Dubois

  7. Department of Digestive Surgery, Hôpital Michallon, Grenoble, France

    Christian Létoublon

  8. Paul Brousse University Hospital, Villejuif, France

    Daniel Cherqui

  9. Department of Digestive and HPB Surgery, Hôpital Henri Mondor, Creteil, France

    Daniel Azoulay

  10. Department of Pediatric Digestive Surgery, Hôpital Necker, Paris, France

    Sabine Irtan

  11. Rennes University Hospital, Rennes, France

    Karim Boudjema

  12. Department of Digestive Surgery and Transplantation, Hôpital Claude Huriez, Lille, France

    François-René Pruvot

  13. Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint Luc, Brussels, Belgium

    Jean-François Gigot

  14. Department of Digestive and Endocrine Surgery, Hospital Robert Debré, Ave du General Koenig, 51090, Reims, France

    Reza Kianmanesh

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  1. Emilia Ragot
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Consortia

Working Group of the French Surgical Association

  • Mustapha Adham
  • , Alexandre Doussot
  • , Sophie Branchereau
  • , Ahmet Ayav
  • , Pierre Balladur
  • , René Adam
  • , Roberto I. Troisi
  • , Marc-Amiens Regimbeau Jean
  • , Pietro Majno
  • , Daniele Sommacale
  • , Chafik Bouzid
  •  & Massimo Falconi

Corresponding author

Correspondence to Reza Kianmanesh.

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Ragot, E., Mabrut, JY., Ouaïssi, M. et al. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC). World J Surg 41, 538–545 (2017). https://doi.org/10.1007/s00268-016-3684-x

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  • DOI: https://doi.org/10.1007/s00268-016-3684-x

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