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Invited Critique |

Prophylactic Excision of the Gallbladder and Bile Duct for Patients With Pancreaticobiliary Maljunction—Invited Critique

William E. Strodel, MD
Arch Surg. 2001;136(7):763. doi:10.1001/archsurg.136.7.763.
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Kobayashi et al present a retrospective review of 68 patients with pancreaticobiliary maljunction. Pancreaticobiliary maljunction or anomalous junction of the pancreaticobiliary ducts is a concept that has received considerable attention over the last 5 to 10 years, particularly from Japanese authors. Various articles have addressed the anatomic anomalous junction of the pancreatic duct and bile duct, the presence or absence of choledochal cyst, and the question of whether reflux of pancreatic juice into the biliary tract increases the likelihood of carcinogenesis in the biliary epithelium. This present study is carefully done and classifies the lesions studied very well. The authors do not specify the definition of PBM, which in the literature is accepted as a common channel between the pancreatic duct and the bile duct of at least 15 mm as measured with either percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography. The authors conclude that in patients with PBM and no evidence of choledochal cyst, the finding of gallbladder carcinoma is extremely high and much greater than expected. The question that is not addressed is how to define the high-risk patient who might have this type of pancreaticobiliary configuration. One article referenced by the authors suggests that patients who have no obvious cause for acute pancreatitis be assessed for anomalous PBM and be considered for cholecystectomy.6

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