Occult pancreaticobiliary reflux is a pathogenic factor of some benign biliary diseases and gallbladder cancer

Lu Wang; Zhi-Wei Zhang; Tong Guo; Peng Xie; Xiao-Rui Huang; Ya-Hong Yu

doi:10.1016/j.hbpd.2022.08.010

Occult pancreaticobiliary reflux is a pathogenic factor of some benign biliary diseases and gallbladder cancer

Hepatobiliary Pancreat Dis Int. 2023 Jun;22(3):288-293. doi: 10.1016/j.hbpd.2022.08.010. Epub 2022 Aug 21.

Authors

Lu Wang¹, Zhi-Wei Zhang², Tong Guo², Peng Xie², Xiao-Rui Huang², Ya-Hong Yu³

Affiliations

¹ Department of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430000, China.
² Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.
³ Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China. Electronic address: yuyahong615@sina.com.

PMID: 36041970
DOI: 10.1016/j.hbpd.2022.08.010

Abstract

Background: Pancreaticobiliary maljunction (PBM) is a well-known high-risk factor for biliary malignant tumors because of constant pancreaticobiliary reflux (PBR). However, the impact of occult pancreaticobiliary reflux (OPR), which is characterized by high bile amylase levels in individuals with anatomically normal pancreaticobiliary junction, on biliary diseases remains unclear. The aim of this study was to assess the correlation between OPR and biliary diseases.

Methods: We enrolled 94 consecutive patients with normal pancreaticobiliary junction and primary biliary diseases confirmed by magnetic resonance cholangiopancreatography. We prospectively collected patients' bile samples and measured bile amylase levels. We investigated the incidence of OPR and the difference in bile amylase levels among these patients and assessed the correlation between high bile amylase levels (HBAL) and benign or malignant biliary diseases, as well as the OPR risk factors.

Results: The incidence of OPR was 36.6% in patients with benign biliary diseases, 26.7% in those with cholangiocarcinoma and 62.5% in those with gallbladder cancer. The median bile amylase level tended to be higher in patients with gallbladder cancer than in those with benign biliary diseases, but there was no significant difference (165.5 IU/L vs. 23.0 IU/L, P = 0.212). The prevalence of an HBAL with bile amylase levels of 1000-7500 IU/L was similar in patients with gallbladder cancer and benign biliary diseases. However, the incidence of HBAL with bile amylase levels greater than 7500 IU/L was significantly higher in patients with gallbladder cancer than in those with benign biliary diseases (37.5% vs. 4.2%, P = 0.012). Multivariate logistic regression analysis revealed that choledocholithiasis was an independent risk factor for OPR.

Conclusions: OPR can occur in benign and malignant biliary diseases, and it may be a pathogenic factor for some benign biliary diseases and a high-risk factor for gallbladder cancer. There is a correlation between choledocholithiasis and OPR.

Keywords: Bile amylase; Biliary diseases; Gallbladder cancer; Occult pancreaticobiliary reflux; Pancreaticobiliary junction.

MeSH terms

Amylases / analysis
Biliary Tract* / pathology
Carcinoma in Situ*
Choledocholithiasis*
Gallbladder Diseases* / diagnostic imaging
Gallbladder Diseases* / epidemiology
Gallbladder Neoplasms* / epidemiology
Gallbladder Neoplasms* / etiology
Gallbladder Neoplasms* / pathology
Humans
Pancreatic Ducts / diagnostic imaging

Substances

Amylases