Pancreaticobiliary Maljunction -Focused on Biliary Carcinogenesis-

Takahiko Funabiki

Dept. of Surgery, Fujita Health University

Collection of large numbers of cases of pancreaticobiliary maljunction (PBM) has shown that PBM without bile duct dilatation is frequently associated with gallbladder carcinoma. Surveys over the last decade, however, show that the incidence of bile duct cancer in PBM without dilatation is not as rare as that of choledochal cyst. The pathology in PBM is a result of reflux of pancreatic juice and stasis of the mixture in the biliary system. The bile acid fractions of bile are altered, and the presence of mutagens has been demonstrated. Dysplasia and hyperplasia are often found in the epithelia of PBM, and proliferative activity is increased, as evidenced by an increased PCNA labeling index and ODC labeling index. Furthermore, K-ras gene mutations, overexpression of p53 protein, p53 gene mutations and p53 LOH have been demonstrated even in non-neoplastic epithelia, especially of bile ducts without dilatation. Judging from the statistical data and the molecular biological data, total resection of an extrahepatic bile duct with gallbladder should be the treatment of choice for the prevention of carcinogenesis, regardless of whether dilatation is present or not. Hepaticoduodenostomy is preferable because it is a less invasive procedure and preserves natural bile flow into the intestinal tract. The incidence of postoperative complications, such as anastomotic stricture and or reflux cholangitis, is low even in cases without dilated bile ducts.

Key words
pancreaticobiliary maljunction, biliary carcinogenesis, gene mutation on biliary epithelium, end-to-side hepaticoduodenostomy, pancreaticobiliary maljunction without biliary dilatation

Reprint requests
Takahiko Funabiki Dept. of Surgery, Fujita Health University School of Medicine1-98 Dengakugakubo, Kutsukake-cho Toyoake, 470-1192 JAPAN

Accepted
December 22, 1999

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