Naoto Urushihara1,2, Yoshinori Hamada1,3, Terumi Kamisawa1,4, Hideki Fujii1,5, Tsugumichi Koshinaga1,6, Yoshiki Morotomi1,7, Takeshi Saito1,8, Takao Itoi1,9, Kenitiro Kaneko10, Hiroaki Fukuzawa11, Hisami Ando1,12. 1. The Committee on Diagnostic Criteria of the Japanese Study Group on Pancreaticobiliary Maljunction, The Com, The Com. 2. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 3. Department of Pediatric Surgery, Kansai Medical University Hirakata Hospital, Hirakata, Japan. 4. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. 5. First Department of Surgery, Yamanashi University Hospital, Kofu, Japan. 6. Department of Pediatric Surgery, Nihon University Itabashi Hospital, Tokyo, Japan. 7. Department of Pediatric Surgery, Osaka City University Hospital, Osaka, Japan. 8. Department of Pediatric Surgery, Chiba University Hospital, Chiba, Japan. 9. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 10. Division of Pediatric Surgery, Department of Surgery, Aichi Medical University Hospital, Aichi, Japan. 11. Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan. 12. Aichi Prefectural Colony, Aichi, Japan.
Abstract
BACKGROUND: In 2015, the Committee on Diagnostic Criteria of the Japanese Study Group on Pancreaticobiliary Maljunction (PBM) proposed a classification of PBM into four types: (A) stenotic type, (B) non-stenotic type, (C) dilated channel type, and (D) complex type. To validate this classification and clarify the clinical features of the four types of PBM, a retrospective multicenter study was conducted. METHODS: The study group of 317 children with PBM was divided into the four types of PBM. Clinical features, preoperative complications, operations, and postoperative pancreatic complications were evaluated. RESULTS: All patients underwent excision of the extrahepatic bile duct. In type A, the age was younger and there was a higher incidence of cystic dilatation. Non-dilatation of the common bile duct was frequently seen in type B. Abdominal pain with hyperamylasemia was frequently seen in types B and C. In particular, the incidence of protein plugs and biliary perforation was high in type C (56.1% and 14.3%, respectively). The overall incidence of acute pancreatitis was 7.3%. Pancreatitis after excisional surgery was rare in the children in this study. Two patients with type D (0.6%) developed chronic pancreatitis postoperatively. CONCLUSIONS: This proposed classification is simple and correlates well with clinical features.
BACKGROUND: In 2015, the Committee on Diagnostic Criteria of the Japanese Study Group on Pancreaticobiliary Maljunction (PBM) proposed a classification of PBM into four types: (A) stenotic type, (B) non-stenotic type, (C) dilated channel type, and (D) complex type. To validate this classification and clarify the clinical features of the four types of PBM, a retrospective multicenter study was conducted. METHODS: The study group of 317 children with PBM was divided into the four types of PBM. Clinical features, preoperative complications, operations, and postoperative pancreatic complications were evaluated. RESULTS: All patients underwent excision of the extrahepatic bile duct. In type A, the age was younger and there was a higher incidence of cystic dilatation. Non-dilatation of the common bile duct was frequently seen in type B. Abdominal pain with hyperamylasemia was frequently seen in types B and C. In particular, the incidence of protein plugs and biliary perforation was high in type C (56.1% and 14.3%, respectively). The overall incidence of acute pancreatitis was 7.3%. Pancreatitis after excisional surgery was rare in the children in this study. Two patients with type D (0.6%) developed chronic pancreatitis postoperatively. CONCLUSIONS: This proposed classification is simple and correlates well with clinical features.