Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

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Abstract

AIM: To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD) on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC). METHODS: This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD. All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acid-enhanced fMRC images showed evidence of pancreatico- biliary reflux of pancreatic secretions. Of the five patients with choledochal cysts, four underwent pylorus-preserving pancreaticoduodenectomy. RESULTS: The five cases of choledochal cysts were classified as Todani classification. In three of the six patients with AUPBD, injected contrast media reached the distal CBD and pancreatic duct on delay images, suggesting biliopancreatic reflux. In two of these six patients, a band-like filling defect was noted in the CBD on pre-fatty meal images, which decreased in size on delayed post-fatty meal images, suggesting pancreatico- biliary reflux of pancreatic secretions, and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L. In one of the six patients with AUPBD, contrast media did not reach the distal CBD due to multiple CBD stones. CONCLUSION: Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico- biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

Original languageEnglish
Pages (from-to)952-959
Number of pages8
JournalWorld Journal of Gastroenterology
Volume18
Issue number9
DOIs
Publication statusPublished - 2012 Mar 7

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Common Bile Duct
Choledochal Cyst
Cholangiography
Magnetic Resonance Spectroscopy
Amylases
Bile
Contrast Media
Meals
Bile Reflux
Pancreaticoduodenectomy
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Pylorus
gadolinium ethoxybenzyl DTPA

Keywords

  • Bile reflux
  • Choledochal cyst
  • Encoscopic retrograde cholangio-pancreatography
  • Gadolinium-ethoxybenzyl- diethylenetriamine penta-acetic acid
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{cee17acbefa940cb883dbbbe45271664,
title = "Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients",
abstract = "AIM: To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD) on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC). METHODS: This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD. All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acid-enhanced fMRC images showed evidence of pancreatico- biliary reflux of pancreatic secretions. Of the five patients with choledochal cysts, four underwent pylorus-preserving pancreaticoduodenectomy. RESULTS: The five cases of choledochal cysts were classified as Todani classification. In three of the six patients with AUPBD, injected contrast media reached the distal CBD and pancreatic duct on delay images, suggesting biliopancreatic reflux. In two of these six patients, a band-like filling defect was noted in the CBD on pre-fatty meal images, which decreased in size on delayed post-fatty meal images, suggesting pancreatico- biliary reflux of pancreatic secretions, and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L. In one of the six patients with AUPBD, contrast media did not reach the distal CBD due to multiple CBD stones. CONCLUSION: Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico- biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.",
keywords = "Bile reflux, Choledochal cyst, Encoscopic retrograde cholangio-pancreatography, Gadolinium-ethoxybenzyl- diethylenetriamine penta-acetic acid, Magnetic resonance imaging",
author = "Yeom, {Suk Keu} and Lee, {Seung Hwa} and Cha, {Sang Hoon} and Chung, {Hwan Hoon} and Bo-Kyung Je and Kim, {Baek Hyun} and Hyun, {Jong Jin}",
year = "2012",
month = "3",
day = "7",
doi = "10.3748/wjg.v18.i9.952",
language = "English",
volume = "18",
pages = "952--959",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
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T1 - Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

AU - Yeom, Suk Keu

AU - Lee, Seung Hwa

AU - Cha, Sang Hoon

AU - Chung, Hwan Hoon

AU - Je, Bo-Kyung

AU - Kim, Baek Hyun

AU - Hyun, Jong Jin

PY - 2012/3/7

Y1 - 2012/3/7

N2 - AIM: To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD) on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC). METHODS: This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD. All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acid-enhanced fMRC images showed evidence of pancreatico- biliary reflux of pancreatic secretions. Of the five patients with choledochal cysts, four underwent pylorus-preserving pancreaticoduodenectomy. RESULTS: The five cases of choledochal cysts were classified as Todani classification. In three of the six patients with AUPBD, injected contrast media reached the distal CBD and pancreatic duct on delay images, suggesting biliopancreatic reflux. In two of these six patients, a band-like filling defect was noted in the CBD on pre-fatty meal images, which decreased in size on delayed post-fatty meal images, suggesting pancreatico- biliary reflux of pancreatic secretions, and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L. In one of the six patients with AUPBD, contrast media did not reach the distal CBD due to multiple CBD stones. CONCLUSION: Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico- biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

AB - AIM: To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD) on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC). METHODS: This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD. All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acid-enhanced fMRC images showed evidence of pancreatico- biliary reflux of pancreatic secretions. Of the five patients with choledochal cysts, four underwent pylorus-preserving pancreaticoduodenectomy. RESULTS: The five cases of choledochal cysts were classified as Todani classification. In three of the six patients with AUPBD, injected contrast media reached the distal CBD and pancreatic duct on delay images, suggesting biliopancreatic reflux. In two of these six patients, a band-like filling defect was noted in the CBD on pre-fatty meal images, which decreased in size on delayed post-fatty meal images, suggesting pancreatico- biliary reflux of pancreatic secretions, and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L. In one of the six patients with AUPBD, contrast media did not reach the distal CBD due to multiple CBD stones. CONCLUSION: Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico- biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

KW - Bile reflux

KW - Choledochal cyst

KW - Encoscopic retrograde cholangio-pancreatography

KW - Gadolinium-ethoxybenzyl- diethylenetriamine penta-acetic acid

KW - Magnetic resonance imaging

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U2 - 10.3748/wjg.v18.i9.952

DO - 10.3748/wjg.v18.i9.952

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EP - 959

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

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