Surgery, Gastroenterology and Oncology

Background: Pancreaticobiliary maljunction (PBM) patients have a high rate of biliary cancers. This study aimed to show strategy for early detection of PBM before the development of biliary cancer.

Methods: We investigated pancreatobiliary complications, age at diagnosis and process of diagnosis in 111 PBM patients (with biliary dilatation (BD) (n=55) and without BD (n=56)).

Results: Eighteen patients of 55 PBM patients with BD(33%: bile duct cancer, n=9; gallbladder cancer, n=10) and 33 of 56 PBM patients without BD (68%: gallbladder cancer only) developed biliary cancer. PBM patients with BD in association with gallbladder cancer were older than those without gallbladder cancer (p<0.01). The number of PBM patients with associated biliary cancer increased with age (p<0.01). Thirteen PBM patients with BD and 33 PBM patients without BD were diagnosed by symptoms due to advanced biliary cancers. PBM without BD was suspected in 9 patients based on findings of gallbladder wall thickening on ultrasonography (US), and the diagnosis was made with magnetic resonance cholangiopancreatography (MRCP) and or endoscopic retrograde cholangiopancreatography before the development of biliary cancer.

Conclusions: For early detection of PBM without BD, MRCP should be performed for individuals showing gallbladder wall thickening on US, even in the absence of symptoms.

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