J Korean Surg Soc.  2013 Feb;84(2):101-106. 10.4174/jkss.2013.84.2.101.

Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults

• Yun SP
• Lee JY
• Jo HJ
• Kim HS
• Kim DH
• Kim JH
• Park SJ
• Park DY
• Seo HI

• KMID: 2144997
• DOI: http://doi.org/10.4174/jkss.2013.84.2.101

Abstract

PURPOSE
The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy.
METHODS
Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia.
RESULTS
Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 +/- 33,592.43 IU/L; group B, 13.06 +/- 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024).
CONCLUSION
Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.

Keyword

Pancreaticobiliary reflux; Amylase; Dysplasia; Ki-67 antigen

MeSH Terms

Adult
Amylases
Bile
Bile Ducts, Extrahepatic
Biliary Tract
Cell Proliferation
Cholecystectomy
Epithelium
Female
Gallbladder
Gallstones
Humans
Immunohistochemistry
Incidence
Inflammation
Ki-67 Antigen
Male
Metaplasia
Pancreatic Juice
Risk Factors
Amylases
Ki-67 Antigen

Figure

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  Fig. 1 (A) Mild inflammation of the gallbladder (H&E, ×100). (B) Moderate inflammation of the gallbladder (H&E, ×100).

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  Fig. 2 (A) Pyloric gland metaplasia in the gallbladder (H&E, ×100). (B) Intestinal metaplasia in the gallbladder (H&E, ×100).

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  Fig. 3 (A) Positive immunochemical staining of p53 in patients with OPBR (×100). (B) SMAD4 immunochemical staining was positive in the gallbladder (×100). (C) Ki-67 immunochemical staining in a dysplastic lesion in the gallbladder (×100).

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