Anatomical Variations and Morphological Diversities of the Pancreatic Ductal System: Clinical and ERCP evaluation

Suh, Jung Hoon; Lee, Jin Heon; Park, Seung Woo; Lee, Joon Kyu; Chung, Jae Bock; Song, Si Young; Kang, Jin Kyung

Abstract

BACKGROUND/AIMS: The advent of endoscopic retrograde cholangiopancreaticography (ERCP) has made it possible to identify the pancreatic ductal (PD) system. There is no established relationship between the PD system and various pancreaticobiliary diseases. The purpose of this study was to identify the morphological diversities and anatomical variations of PD and to define the relationship between PD types and pancreaticobiliary diseases.
METHODS
Five hundred and eighty-two consecutive patients, in whom both PD and common bile duct (CBD) were clearly visualized by ERCP, were included. PD types were categorized according to the relationship between CBD and PD. The anatomical variations were classified into migration, fusion, and duplication anomalies.
RESULTS
The PD types were classified into type A 84.4%, type B 9.6%, type C 3.4%, and type D 2.6%. The PD anomalies were noted in 51 patients, which were comprised of 19 (3.3%) fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum) and 32 (5.5%) duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. Hyperamylasemia was more frequently complicated in type C (41.7%) and D (50%) than in type A and B after ERCP.
CONCLUSIONS
Though a close relationship was not found between various PD types and pancreaticobiliary diseases, being familiar with the morphology and anatomical variation is worth it, for more accurate interpretation and for prediction of a complication such as pancreatitis.