Imaging Diagnosis Of Adult Pancreaticobiliary Reflux And Its Correlation With Gallbladder Diseases

Objective Pancreatobiliary reflux(PBR)refers to the reflux of pancreatic juice into the bile duct.This study collected data from adult patients admitted to the hospital for bile amylase(BA)testing and imaging examinations due to gallbladder disease.The imaging results of these patients were analyzed and the correlation between PBR and gallbladder disease was studied,in order to enhance clinical understanding of PBR and attach importance to its role in the occurrence and development of gallbladder related diseases.Methods We collected 150 adult cases of gallbladder disease and surgical treatment date in our hospital from March 2021 to July 2022,including gallbladder stones,gallbladder polyps,and gallbladder cancer.The patient underwent BA level testing,imaging examination,and histopathological examination of the tissue samples obtained during surgery.This study used diagnostic criteria for PBR established by the Japanese Study Group on Pancreatobiliary Maljunction(JSPBM),that BA is higher than the normal upper limit of serum amylase(SA)(abnormally elevated BA levels).Patients with intraoperative BA levels higher than the upper normal limit of SA were included in the PBR group.Patients with intraoperative BA levels below the normal upper limit of SA were included in the control group.Results This study used abnormally high BA levels(>135U/L)as the diagnostic criteria for PBR.The sensitivity,specificity,and accuracy of the indirect sign of gallbladder wall thickening(≥3mm)in ultrasound examination(Ultrasound,US)for diagnosing PBR were 77%,39%,and 49%,respectively.The sensitivity,specificity,and accuracy of the indirect sign of extrahepatic bile duct widening(≥ 8mm)for diagnosing PBR were 56%,49%,and 51%,respectively.Parallel connection of two indirect signs in US examination(thickening of gallbladder wall and widening of upper diameter of extrahepatic bile duct)is sufficient to diagnose PBR,with a net sensitivity of 90% and a net specificity of 19%.Magnetic resonance cholangiopancreatography(MRCP)has a sensitivity of 55%,specificity of 90%,and accuracy of 77% for the diagnosis of PBR.Computed Tomography(CT)has a sensitivity of 44%,specificity of 90%,and accuracy of 73% for the diagnosis of PBR.The sensitivity,specificity,and accuracy of intraoperative cholangiography(IOC)in the diagnosis of PBR are 81%,75%,and 79%,respectively.The PBR group included 39 patients with gallbladder diseases were divided into three groups,including 11 cases of gallbladder stones,13 cases of gallbladder polyps,and 15 cases of gallbladder cancer.The control group included 111 patients with gallbladder diseases were divided into three groups,including 48 cases of gallbladder stones,39 cases of gallbladder polyps,and 24 cases of gallbladder cancer.There was a significant difference in the incidence of gallbladder cancer between the two groups,and the difference was statistically significant(X~2=4.25,P<0.05),there was no statistically significant difference in the incidence of gallbladder stones and polyps between the two groups of cases(X~2=2.73,X~2=0.04,P>0.05).The BA levels in the PBR group were significantly higher than those in the control group(P<0.05),there was no significant difference in SA levels between the PBR group and the control group(P>0.05).The BA levels of gallbladder cancer in the PBR group were significantly higher than those of gallbladder stones and polyps(P<0.05).In this study,the BA levels of gallbladder cancer patients were significantly higher than those of gallbladder stone and gallbladder polyp patients(P<0.01),and there was no statistically significant difference in SA levels(P>0.05).Conclusions US has high sensitivity in the diagnosis of PBR through parallel indirect signs(thickening of the gallbladder wall and widening of the inner diameter of the upper segment of the extrahepatic bile duct),and can be used as a preliminary screening diagnostic method for suspected PBR in clinical practice.MRCP and contrast-enhanced CT have high specificity in the diagnosis of PBR,and can be used as second-line imaging diagnostic methods for PBR in clinical practice.IOC not only has high sensitivity and specificity in the diagnosis of PBR,but also can serve as a supplement to the second line imaging method for further improving the accuracy of PBR diagnosis in clinical practice.There is a correlation between PBR and gallbladder cancer.