Abstract
The sphincter of Oddi regulates the outflow of bile and pancreatic juice. In pancreaticobiliary maljunction, the junction of the pancreatic and bile ducts is located outside of the duodenal wall, and the action of the sphincter does not functionally affect the pancreaticobiliary junction. Since the hydropressure is normally higher within the pancreatic duct than within the bile duct, reflux of pancreatic juice into the biliary duct frequently occurs in PBM, resulting in carcinogenesis in the biliary tract. Diagnosis of pancreaticobiliary reflux can be diagnosed from elevated amylase levels in the bile, secretin-stimulated dynamic magnetic resonance cholangiopancreatography, and pancreatography via the minor duodenal papilla. Pancreaticobiliary reflux also occurs in high confluence of the pancreaticobiliary ducts which is defined as a common channel length of ≥6 mm, with occlusion of communication when the sphincter contracts. It can occur even in some individuals with normal pancreaticobiliary junction. Although pancreaticobiliary reflux might be related to carcinogenesis of the gallbladder, the clinical relevance of pancreaticobiliary reflux in individuals with normal pancreaticobiliary junctions is unknown. Further prospective clinical studies are needed in order to clarify the clinical implications, including appropriate management, in pancreaticobiliary reflux of individuals without PBM.
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Acknowledgments
This work was supported by a grant from the Ministry of Health, Labor, and Welfare of Japan (H28-nanchitou(nan)-ippan-021, research on rare and intractable diseases, and Health and Labor Sciences Research Grants.
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Kamisawa, T., Kuruma, S., Chiba, K., Kikuyama, M. (2018). Pancreaticobiliary Reflux. In: Kamisawa, T., Ando, H. (eds) Pancreaticobiliary Maljunction and Congenital Biliary Dilatation. Springer, Singapore. https://doi.org/10.1007/978-981-10-8654-0_10
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DOI: https://doi.org/10.1007/978-981-10-8654-0_10
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