Anat Cell Biol.  2024 Mar;57(1):31-44. 10.5115/acb.23.148.

Exploring the variations of the pancreatic ductal system: a systematic review and metaanalysis of observational studies

• Asghar A
• Narayan RK
• Pushpa NB
• Patra A
• Ravi KS
• Tubbs R

• KMID: 2554239
• DOI: http://doi.org/10.5115/acb.23.148

Abstract

The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS, addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar databases were searched to identify publications relevant to this review. R studio with meta-package was used for data extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type 3 variants and “descending” subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or pseudocysts formation.

Keyword

Cholangiopancreatography; Accessory pancreatic duct; Endoscopic retrograde cholangiopancreatography; Magnetic resonance cholangiopancreatography; Pancreatitis

Figure

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  Fig. 1 Development of pancreas. (A) the ventral (Ve) and dorsal (Do) buds of the pancreas develop opposite to each other at the junction of foregut and midgut. (B) The ventral bud undergoes clockwise rotation around the caudal part of the foregut. (C) The dorsal and ventral pancreatic ducts fuse in the region of the neck of pancreas. (D) The fused ventral pancreatic duct and the proximal part of dorsal pancreatic duct forms the main pancreatic duct, while the remaining distal portion of the dorsal pancreatic duct may persist as accessory pancreatic duct.

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  Fig. 2 Shows the configurational variants of the pancreatic ductal system (PDS). Types 1–3 shows normal pancreatic variants, and types 4, 5 shows variants of pancreas divisum. MP, major duodenal papilla; MiP, minor duodenal papilla.

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  Fig. 3 Variants of the main pancreatic duct. Adapted from Türkvatan et al. Korean J Radiol 2013;14:905-13 [12].

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  Fig. 4 Variants of the accessory pancreatic duct (A) long type, (B) short type. MP, major duodenal papilla; MiP, minor duodenal papilla. Adapted from Kamisawa et al. World J Gastroenterol 2010;16:4499-503 [17].

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  Fig. 5 PRISMA flow-diagram for systematic review.

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  Fig. 6 Forest plot showing pooled estimate of the length of (A) the main pancreatic duct, and (B) the accessory pancreatic duct. SD, standard deviation; IV, inverse variance; CI, confidence interval; ERCP, endoscopic retrograde cholangiopancreatography.

Reference

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