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Zhang T, Shi X, Li J, Zhang J, Li X, Ren G, Luo H, Kang X, Liang S, Wang X, Pan Y. Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study. Gastroenterol Rep (Oxf) 2024; 12:goae059. [PMID: 38863808 PMCID: PMC11165313 DOI: 10.1093/gastro/goae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 06/13/2024] Open
Abstract
Background Horizontal duodenal papilla (HDP) is not an uncommon ectopic major papilla. The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear. Here, we explored the associations in patients who underwent magnetic resonance cholangiopancreatography (MRCP). Methods Consecutive patients who underwent MRCP at Xijing Hospital (Xi'an, China) between January 2020 and December 2021 were eligible. Patients were divided into HDP and regular papilla (RP) according to the position of the major papilla. The primary outcome was the proportion of congenital pancreaticobiliary diseases. Results A total of 2,194 patients were included, of whom 72 (3.3%) had HDP. Compared with the RP group (n = 2,122), the HDP group had a higher proportion of congenital pancreaticobiliary diseases, especially choledochal cyst (CC) or anomalous pancreaticobiliary junction (APBJ) (6.9% vs 1.4%, P = 0.001). More gallbladder cancer (6.9% vs 1.2%, P < 0.001) and pancreatic cysts (27.8% vs 16.3%, P = 0.01) were also identified in the HDP group. Morphologically, the HDP group had a longer extrahepatic bile duct (8.4 [7.6-9.3] cm vs 7.2 [6.5-8.1] cm, P < 0.001), and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum. Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. Conclusions This study confirmed that HDP was not rare in patients underwent MRCP. A higher prevalence of congenital pancreaticobiliary malformations (especially CC or APBJ), gallbladder cancer and pancreatic cysts was observed in patients with HDP, as well as distinctive morphologic features.
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Affiliation(s)
- Tiantian Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Gastroenterology, Xi’an Medical University, Xi’an, Shaanxi, P. R. China
| | - Xin Shi
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Pathology, Lanzhou Petrified Total Hospital, Lanzhou, Gansu, P. R. China
| | - Jing Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Jingsong Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xixian Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Gastroenterology, Xi’an Medical University, Xi’an, Shaanxi, P. R. China
| | - Gui Ren
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Hui Luo
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xiaoyu Kang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Shuhui Liang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xiangping Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Yanglin Pan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
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Ari D, Ödemiş B, Başpinar B, Atay A, Erdoğan Ç. Ectopic Opening of Common Bile Duct to Duodenal Bulb: A Single Tertiary Center Experience. Surg Laparosc Endosc Percutan Tech 2023; 33:640-644. [PMID: 37725829 DOI: 10.1097/sle.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The ectopic opening of the common bile duct(CBD) into the duodenal bulb is a rare biliary anomaly. The study aimed to reveal the experience with clinical and endoscopic outcomes in these patients. MATERIALS AND METHODS This study was conducted on 57 consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for ectopic opening of the CBD into the duodenal bulb at our institution between 2010 and 2020. RESULTS The median age was 59 years (49 males). A total of 146 ERCP procedures were performed (once in 26 patients and 2 or more times in 31 patients). Ten patients had a history of unsuccessful ERCP in an external center. The median follow-up time was 14.6 months. All patients had a slit-like opening of the CBD into the duodenal bulb, apical stenosis, and hook-shaped distal CBD. ERCP findings were CBD stone or dilatation in 55 patients and post-cholecystectomy biliary leakage in 2 patients. Balloon dilatation was performed for apical stenosis in 7 patients and distal CBD stenosis in 26 patients. During the first ERCP session, biliary stent/nasobiliary drainage was placed in 37 patients, and CBD stones were extracted in 19 patients without stenting. Biliodigestive anastomosis was applied to 13 patients, 5 of whom had recurrent cholangitis, 7 required recurrent ERCP, and one was due to the technical difficulty of ERCP. CONCLUSIONS Ectopic biliary opening should be remembered if the papilla cannot be seen in its usual place in a patient with apical stenosis. ERCP should be performed in experienced hands, and surgery should be considered in the need for recurrent ERCP.
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Affiliation(s)
- Derya Ari
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage. ACG Case Rep J 2023; 10:e00973. [PMID: 36819478 PMCID: PMC9935988 DOI: 10.14309/crj.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
Abstract
Ectopic opening of the common bile duct is a rare anatomic variant that is associated with increased risk of complications such as cholangitis, peptic ulcer disease, and even cholangiocarcinoma. Ectopic opening of the common bile duct into the duodenal bulb is a rare form of ectopic opening of the common bile duct accounting for 0.1%-2.7% of cases of anomalous biliary drainage. Identification of such pathology is important because of its varied presentation and considerable operative and procedural implications. We report a rare case of duodenal bulb opening of the common bile duct in a patient who presented with cholangitis.
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Karabulut Ü, Üzel A, Yolaçan R, Uçmak F, Kaya M. Ectopic Opening of Common Bile Duct into Duodenal Bulb and Gastric Antrum and Its Importance. ARCHIVES OF IRANIAN MEDICINE 2022; 25:706-711. [PMID: 37542403 PMCID: PMC10685873 DOI: 10.34172/aim.2022.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/08/2021] [Indexed: 08/06/2023]
Abstract
BACKGROUND Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality. METHODS This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients. CONCLUSION Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.
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Affiliation(s)
- Ümit Karabulut
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Ali Üzel
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Ramazan Yolaçan
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Feyzullah Uçmak
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Muhsin Kaya
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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Alkarboly T, Gharib DT, Salih KM, Mustafa SM, Salih AM, Kakamad FH. Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review. Int J Surg Case Rep 2022; 93:106887. [PMID: 35305424 PMCID: PMC8928074 DOI: 10.1016/j.ijscr.2022.106887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 10/25/2022] Open
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Kobayashi K, Murayama M, Sugasawa H, Nishikawa M, Nishiyama K, Takeo H. Duodenal stenosis associated with an ectopic opening of the common bile duct into the duodenal bulb: a case report. Surg Case Rep 2021; 7:257. [PMID: 34914022 PMCID: PMC8677856 DOI: 10.1186/s40792-021-01351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct into the duodenal bulb. Case presentation A 54-year-old man was referred with fever, nausea, and vomiting. He had experienced epigastric pain several times over the past 30 years. Endoscopy showed a post-bulbar ulcer, a submucosal tumor of the duodenum, and a small opening with bile secretion. Contrast duodenography revealed duodenal stenosis and bile reflux with a common bile duct deformity. Pancreatoduodenectomy was performed because of the clinical suspicion of a biliary neoplasm or groove pancreatitis. The resected specimen showed an ectopic opening of the common bile duct into the duodenal bulb and no tumor. Conclusions Ectopic opening of the common bile duct into the duodenal bulb is complicated by a duodenal ulcer, deformity, and stenosis mimicking groove pancreatitis or pancreatic tumors. Although rare, we should be aware of this anomaly for an accurate diagnosis.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan.
| | - Michinori Murayama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Makoto Nishikawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Kiyoshi Nishiyama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
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Xu H, Li X, Zhu KX, Zhou WC. Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report. World J Clin Cases 2021; 9:5332-5338. [PMID: 34307586 PMCID: PMC8283612 DOI: 10.12998/wjcc.v9.i19.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.
CASE SUMMARY A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.
CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.
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Affiliation(s)
- Hao Xu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xin Li
- The First Clinical Medical School of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Xiang Zhu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Ce Zhou
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Comparison of the procedure results of ectopic papillae encountered during ERCP procedure with the procedure results of papillae with normal localization. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.843063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jeon HJ, Lee JM, Lee HS. Long Cylindrical Filling Defects in Bile Duct. Gastroenterology 2020; 159:e8-e9. [PMID: 32311366 DOI: 10.1053/j.gastro.2020.03.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/24/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Abstract
INTRODUCTION Gastroesophageal reflux disease is a common and troublesome condition. This paper reports a rare case of gastroesophageal reflux disease caused by ectopic biliary drainage accompanying the absence of a pyloric channel and duodenal bulb in a female patient with multiple underlying malformations. PATIENT CONCERNS A 24-year-old female presented with acid regurgitation and abdominal pain for one month. She was born two weeks premature and with blindness of the right eye. Cardiac murmur was detected in the physical examination. DIAGNOSIS Gastroendoscopy was performed, and a class D reflux esophagitis and ectopic papilla complicated with the absence of a pyloric channel and duodenal bulb were found. Doppler echocardiography further confirmed the defects of atrial and ventricular septa. Trio-based whole exome sequencing was performed on the proband and her family to find the potential association of multiple variations. However, no putative pathogenic mutations were found. INTERVENTIONS The patient received proton pump inhibitors and prokinetic treatment and underwent surgical repair of septal defects. OUTCOMES The symptoms were quickly relieved, and the patient was kept stable upon follow-up. CONCLUSION The combination of an absent pylorus and ectopic papilla is a rare cause of reflux esophagitis. Unusual gastrointestinal anatomical variations may be accompanied by other malformations. Though no remarkable mutation were detected in this case, sequencing is an efficient technique worth full consideration.
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Affiliation(s)
- Jia-Yi Ma
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Lai VC, Lai EC, Tang CN. Intraductal papillary neoplasm in common bile duct opening into the stomach. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria Cindy Lai
- Department of SurgeryPamela Youde Nethersole Eastern Hospital Hong Kong China
| | - Eric C.H. Lai
- Department of SurgeryPamela Youde Nethersole Eastern Hospital Hong Kong China
| | - Chung Ngai Tang
- Department of SurgeryPamela Youde Nethersole Eastern Hospital Hong Kong China
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Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography. Surg Laparosc Endosc Percutan Tech 2020; 29:399-404. [PMID: 31246750 DOI: 10.1097/sle.0000000000000695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Ectopic opening of the common bile duct (EO-CBD) is a rare pathology, and its management is important. To date, only a few studies have been conducted for EO-CBD due to its low incidence. MATERIALS AND METHODS A retrospective review was conducted on 54 patients with available prospective data. Among them, 30 patients (group 1) underwent choledochoduodenostomy for reasons other than anomalous opening, and 24 patients (group 2) had an EO-CBD. RESULTS Endoscopic retrograde cholangiopancreatography (ERCP) was performed for 24 patients with duodenal deformity and apical stenosis. EO-CBD was detected in 2.72% of all patients who underwent ERCP (24/880 ERCPs). The occurrence of hyperbilirubinemia (total bilirubin >1.2 mg/dL) was not significantly different between groups: 3.83±4.57 mg/dL for group 1 and 2.26±2.17 mg/dL for group 2. CONCLUSIONS Failed ERCP, giant stones, and recurrent episodes (>2) of cholangitis requiring ERCP constitute indications for surgical treatment in cases of EO-CBD into the duodenum.
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Hong J, Pan W, Zuo W, Wang A, Zhu L, Zhou X, Zhou X, Li G, Liu Z, Liu P, Zhen H, Zhu Y, Ma J, Yuan J, Shu X, Zhu Y, Lu N, Chen Y. Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater. Medicine (Baltimore) 2020; 99:e18536. [PMID: 31895789 PMCID: PMC6946525 DOI: 10.1097/md.0000000000018536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It remains challenging for endoscopists to manage pancreaticobiliary diseases in patients with ectopic papilla of Vater by endoscopic retrograde cholangiopancreatography (ERCP). The present study sought to evaluate the efficacy and safety of ERCP for this issue.Consecutive patients with ectopic papilla of Vater who underwent initial ERCP due to pancreaticobiliary diseases were retrospectively analyzed.One hundred seven patients with ectopic papilla of Vater were included. The success rate of cannulation was 83.2%. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and mechanical lithotripsy were performed in 12 (11.2%), 25 (23.4%), and 1 (0.9%) patients, respectively. The technical success rate was 83.2%; of these, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoscopic retrograde pancreatic drainage, and stone extraction was conducted in 61 (57.0%), 17 (15.9%), 5 (4.7%), and 45 (42.1%) patients, respectively. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis were risk factors for stone extraction inability. Adverse events occurred in 20 (18.7%) patients, including post-ERCP pancreatitis (3.7%), hyperamylasemia (12.1%), and infection of biliary tract (2.8%); all of the adverse events were mild and alleviated by conventional therapies.ERCP is an appropriate choice for pancreaticobiliary diseases in patients with ectopic papilla of Vater due to its high efficacy and safety. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis increase difficulties for stone extraction.
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Affiliation(s)
| | | | - Wei Zuo
- Department of Respiratory Medicine
| | | | | | | | | | | | | | - Pi Liu
- Department of Gastroenterology
| | | | | | | | - Jianhui Yuan
- Endoscopy Center
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology
| | - Yin Zhu
- Department of Gastroenterology
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Kinowaki Y, Takazawa Y, Yamamoto N, Ishikawa Y. Intraductal papillary mucinous neoplasm involving pancreaticobiliary maljunction and an aberrant pancreatic duct draining into the stomach: A case report and review of the literature. Pathol Res Pract 2016; 212:139-44. [DOI: 10.1016/j.prp.2015.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 12/01/2022]
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Takikawa T, Kanno A, Masamune A, Hongo S, Yoshida N, Nakano E, Miura S, Hamada S, Kume K, Kikuta K, Hirota M, Shimosegawa T. Ectopic Opening of the Common Bile Duct Accompanied by Choledochocele and Pancreas Divisum. Intern Med 2016; 55:1097-102. [PMID: 27150861 DOI: 10.2169/internalmedicine.55.6240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 32-year-old woman was referred due to abdominal pain and elevated liver enzymes. Computed tomography and magnetic resonance imaging showed ectopic opening of the common bile duct (CBD) into the duodenal bulb. Esophagogastroduodenoscopy showed a hemispheric bulge in the duodenal bulb. Endoscopic retrograde cholangiopancreatography (ERCP) revealed the bulge to be cystic dilatation of the CBD. ERCP also showed no communication between the ventral and dorsal pancreatic ducts. We diagnosed the patient with ectopic opening of the CBD accompanied by choledochocele and pancreas divisum. Endoscopic incision was performed for the treatment of the choledochocele. The patient's symptoms and elevated liver enzymes improved after treatment.
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Affiliation(s)
- Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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Song CH, Zhou XJ, Liu P, Zeng H, Zhu Y, Liu ZJ, Guo GH, Li GH, Chen YX, Lv NH. Endoscopic diagnosis and management of ectopic duodenal papilla. Shijie Huaren Xiaohua Zazhi 2015; 23:5527-5532. [DOI: 10.11569/wcjd.v23.i34.5527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the endoscopic diagnosis and management of ectopic duodenal papilla.
METHODS: Clinical data for 8869 consecutive patients who underwent endoscopic retrograde cholangio-pancreatography (ERCP) from May 2007 to May 2015 at the First Affiliated Hospital of Nanchang University were reviewed. Of these patients, 43 cases of ectopic duodenal papilla were identified and analyzed retrospectively to summarize the location of ectopic papilla, related disease, and key points of ERCP diagnosis and management.
RESULTS: Among the 43 cases, 36 had obvious ectopic orifice and 7 did not. Ectopic papilla were located in the duodenal bulb in 7 cases, in the junction of the bulb and the descending portion of the duodenum in 34 cases, and in the horizontal portion of the duodenum in 2 cases. The related diseases were choledocholithiasis without complications in 27 cases, acute obstructive suppurative cholangitis in 5 cases, biliary pancreatitis in 7, simple bile duct cystic dilatation in 3, and choledochectasia with pancreatic divisum in 1. Ultimately, 36 patients underwent ERCP and 30 (83.33%) were succeeding in biliary cannulation. There was 1 case of cholangitis, 1 case of mild acute pancreatitis and 2 cases of hyperamylasemia. No hemorrhage or perforation occurred.
CONCLUSION: The location of ectopic duodenal papilla is diverse, with the junction of the bulb and the descending portion of the duodenum being the most common site. Skilled operations may contribute to improving the success rate and decreasing complications of ERCP.
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