Dontheneni Shravya Bhargavi, Kotha Aasritha, Putta Tharani, Chapala Shashank, Nagipagu Suvarna Naidu
Asian Institute of Gastroenterology, Hyderabad, India.
Abdom Radiol (NY). 2025 Apr 3. doi: 10.1007/s00261-025-04917-9.
To evaluate the prevalence of abnormal pancreaticobiliary junction (APBJ) on Magnetic Resonance Cholangio-Pancreatography (MRCP) in patients with and without choledochal cyst (CDC), and study their clinico-radiological profile.
We have retrospectively screened all MRCP studies (n = 13,482) done in our Radiology department over 18 months and documented the presence and type of APBJ (any length of extra-duodenal common channel) and CDC, other co-existing pancreaticobiliary abnormalities including complications.
Prevalence of APBJ was 0.5% (n = 67) with 77% of them showing CDC (52/67) while only 0.85% of patients without APBJ have CDC (p value < 0.0001). The most common type of CDC associated with APBJ was Todani Type I (86%) followed by type IV (14%). 31% of CDC patients had APBJ (52 out of 165) while the majority of patients with CDC (69%) did not have APBJ. Between the CDC (n = 52) and non-CDC (n = 15) subgroups of APBJ, there was statistically significant difference in the age (25 vs. 40 years, p value 0.003), gender, length of common channel (14.4 ± 6 mm vs. 10.6 ± 5 mm, p value 0.03), JSPBM type of APBJ and the risk of biliary malignancy (1.9% vs. 26.7%, p value 0.008, Odds ratio 13.8). Although idiopathic pancreatitis was also more common in the non-CDC subgroup, this difference was not statistically significant. There was no statistical correlation between the length of common channel and occurrence of CDC, biliary calculi, malignancy or pancreatitis.
Any length of common pancreaticobiliary channel outside the duodenal wall must be considered as APBJ; there is no correlation between the actual length of common channel and occurrence of its complications. The often overlooked and underdiagnosed subgroup of APBJ without biliary dilatation are 13.8 times more likely to develop biliary malignancy than the CDC group. We therefore suggest a necessary shift in surveillance strategies and advocate for routine screening of patients with APBJ for any biliary malignancy, even in the absence of CDC, and perhaps subject them to prophylactic cholecystectomy.
评估磁共振胰胆管造影（MRCP）检查中，胆总管囊肿（CDC）患者及非胆总管囊肿患者胰胆管异常连接（APBJ）的发生率，并研究其临床放射学特征。
我们回顾性筛查了放射科在18个月内完成的所有MRCP检查（n = 13482例），记录APBJ（十二指肠外共同通道的任何长度）和CDC的存在情况及类型，以及其他并存的胰胆管异常，包括并发症。
APBJ的发生率为0.5%（n = 67），其中77%伴有CDC（52/67），而无APBJ的患者中只有0.85%患有CDC（p值<0.0001）。与APBJ相关的最常见的CDC类型是Todani I型（86%），其次是IV型（14%）。31%的CDC患者有APBJ（165例中有52例），而大多数CDC患者（69%）没有APBJ。在APBJ的CDC亚组（n = 52）和非CDC亚组（n = 15）之间，年龄（25岁对40岁，p值0.003）、性别、共同通道长度（14.4±6mm对10.6±5mm，p值0.03）、APBJ的JSPBM类型以及胆道恶性肿瘤风险（1.9%对26.7%，p值0.008，比值比13.8）存在统计学显著差异。虽然特发性胰腺炎在非CDC亚组中也更常见，但这种差异无统计学意义。共同通道长度与CDC、胆结石、恶性肿瘤或胰腺炎的发生之间无统计学相关性。
十二指肠壁外任何长度的胰胆管共同通道都应视为APBJ；共同通道的实际长度与其并发症的发生之间无相关性。未合并胆管扩张的APBJ这一常被忽视和漏诊的亚组发生胆道恶性肿瘤的可能性是CDC组的13.8倍。因此，我们建议在监测策略上进行必要的转变，并提倡对APBJ患者进行常规筛查以发现任何胆道恶性肿瘤，即使在没有CDC的情况下，或许还应对其进行预防性胆囊切除术。
