The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

다국어 초록 (Multilingual Abstract)

The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure- related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

참고문헌 (Reference)

1 "to the common bile duct and to the duodenum" acta anat 1950 : 9-,

2 "its association with pancreatitis" 539-43, amjsurg1977

3 "an attempt at consensus" Endoscopic sphincterotomy complications and their management 383-93, gastrointestendosc1991

4 "Variations and anomalies of the papilla of Vater" 70-7, endoscopy1974

5 "Variants of pancreatic duct system of importance in endoscopic retrograde cholangiopancreatography Observations on autopsy specimens" 113-28, 1983

6 "Risk factor for extrahepatic bile duct cancer in patients with anomalous pancreaticobiliary ductal union" 51 : 946-949, 2004

7 "Prospective comparison of transcutaneous 3-dimensional US cholangiography, magnetic resonance cholangiography, and direct cholangiography in the evaluation of malignant biliary obstruction" 58 : 853-858, 2003

8 "Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors" 34 : 286-292, 2002

9 "Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors" 10 : 423-428, 1998

10 "Pancreatic development and anatomical variation" 5 : 1-30, 1995

11 "Pancreas divisum is a probable cause of acute pancreatitis a report of 137 cases" 248-54, pancreas1990

12 "Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study" 48 : 1-10, 1998

13 "Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis" 15 : 809-813, 2003

14 "Hyperamylasaemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography" 160-3, pancreas1986

15 "Hormonal and biochemical changes following endoscopic retrograde cholangio-pancreatography" 538-44, actagastroenterolbelg1981

16 "Gross anatomy" 31-19 52, 1984

17 "Fusion anomalies of the pancreatic ductal system differentiation from pathologic states" 637-42, radiology1977

18 "Fusion and duplication variants of pancreatic duct system" 17 : 23-28, 1995

19 "Evaluation of post-ERCP pancreatitis: potential causes noted during controlled study of differing contrast media" Midwest Pancreaticobiliary Study Group 46 : 217-222, 1997

20 "Endoscopic pancreatocholangiography" 103-6, endoscopy1970

21 "Diagnostic aspects of incomplete pancreas divisum" gastrointestendosc1986

22 "Cost-minimization analysis of MRC versus ERCP for the diagnosis of primary sclerosing cholangitis" 40 : 39-45, 2004

23 "Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis" 105-14,

24 "Complications of endoscopic biliary sphincterotomy" 335 : 909-918, 1996

25 "Clinical significance of pancreas divisum" 306-13, actagastroenterolbelg1992

26 "Association of pancreatitis and variant ductal anatomy dominant drainage of the duct of Santorini" 158-62, amjgastroenterol1978

27 "Anomalous pancreaticobiliary ductal union- an etiologic association of gallbladder cancer and adenomyomatosis" 45 : 2016-2019, 1998

28 "Anatomy of the pancreas" 795-802,

29 "An anatomical-radiological study on the pancreatic duct pattern in man" 59-68, anatrec1961