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A NOVEL PANCREATICOBILIARY JUNCTION RATIO: AN EVALUATION OF RISK DETERMINANTS FOR BILIARY DISEASE
Colin Tang-Whitmore
*1, Pravin D. Meshram
1, Sean H. Nguyen
1, Anthony J. Weinhaus
2, Emma K. Jones
1, Nabeel Azeem
3, James V. Harmon
11Department of Surgery, University of Minnesota, Minneapolis, MN; 2Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN; 3Department of Medicine, Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, MN
Background: Research suggests that variations in the anatomy of the pancreaticobiliary tree may increase the risk of extrahepatic biliary disease, possibly due to prolonged bile duct exposure to pancreatic secretions. The anatomic determinants of extrahepatic biliary disease have been explored. We propose using a ratio rather than length alone, to account for body habitus and refine the impact of anatomic variation on extrahepatic biliary disease.
Methods: Consecutive digital magnetic resonance cholangiopancreatography (MRCP) images that permitted measurements of the targeted anatomy were obtained from published literature. Images were analyzed using a flexible measurement device to determine the ratio of the length of the post-pancreatic common channel (PostPCC) to the length of the pre-pancreatic bile duct (PrePBD) called the PostPCC/PrePBD ratio. The PrePBD/PostPCC ratio was calculated in the following groups: MRCPs without structural biliary disease and MRCPs from patients with structural biliary disease (including long common channel, pancreaticobiliary maljunction, or the presence of type I choledochal cyst). As all of the digital MRCP PostPCC/PrePBD ratios were obtained using a two-dimensional platform, we then calculated the PostPCC/PrePBD ratios using the anatomic structures of the biliary tree dissected in the human anatomy laboratory. In the anatomy laboratory, 11 consecutive human cadavers who had available targeted anatomy were dissected to examine the biliary system. We used a measuring tool to measure the PrePBD and the PostPCC. We calculated the mean and standard deviation for the derived ratios. Wilcoxon rank sum tests were performed to compare normal and aberrant MRCP ratios and the normal MRCP ratios with the ratios from the human anatomy dissections.
Results: The PostPCC/PrePBD ratio for normal MRCP images was 0.087 ± 0.026 (n = 20). The PostPCC/PrePBD ratio for aberrant MRCP images was 0.347 ± 0.190 (n = 20). This difference was highly significant; p < 0.001. The corroborative evaluation of human bile duct dissections performed in the anatomy lab revealed a PostPCC/PrePBD ratio of 0.156 ± 0.082 (n = 11). A significant difference was demonstrated between the PostPCC/PrePBD ratio of the human bile duct dissections and the normal MRCP images p = 0.003.
Conclusion: This pilot study demonstrated the potential use of the PostPCC/PrePBD ratio to define structural differences in the pancreaticobiliary ductal system that may impact biliary and pancreatic pathology. We intend to clinically correlate this ratio with pathology in a larger patient cohort as well as
explore the clinical relevance of this ratio as a tool for predicting the risk of the development of extrahepatic biliary disease.
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