Correlation of ectopic distal location of papilla of Vater and clinical characteristics in pediatric choledochal cysts

Chen, Suyun; Yin, Tong; Li, Long; Diao, Mei; Huang, Ting

doi:10.1007/s00383-023-05486-y

Cited by 3 publications

(3 citation statements)

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“…An ectopic distal location of the hepatic diverticulum could cause stretching and weakness of the common bile duct and common channel, leading to distal stenosis and a longer common channel, ultimately resulting in choledochal cysts [ 10 ]. Our previous report showed that patients with a more distal location of the papilla of Vater had larger cysts and more severe clinical features [ 11 ]. This study further demonstrated a correlation between the location of the papilla and serum MMP-7, with more distal locations associated with higher levels of MMP-7.…”

Section: Discussionmentioning

confidence: 99%

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Relationships of serum MMP-7 and clinical characteristics in choledochal cyst children

Yin,

Chen,

Zhou

et al. 2024

BMC Surg

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Background Matrix metalloproteinase-7 (MMP-7) is associated with biliary injury. This study aimed to evaluate the relationships of serum MMP-7 with clinical characteristics in choledochal cysts (CDC) children. Methods Between June 2020 and July 2022, we conducted a prospective study of CDCs who underwent one-stage definitive operation at our center. Serum MMP-7 was measured using an enzyme-linked immunosorbent assay. We evaluated the relationships between serum MMP-7 and age, laboratory tests, imaging examinations, liver fibrosis, MMP-7 expression, and perforation. Results A total of 328 CDCs were enrolled in the study, with a median serum MMP-7 of 7.67 ng/mL. Higher serum MMP-7 was correlated with younger age at diagnosis (p < 0.001), larger cyst sizes (p < 0.001), higher liver fibrosis stages (p < 0.001), and higher incidence of perforation (p < 0.01). Liver MMP-7 was mainly expressed in intrahepatic and extrahepatic biliary epithelial cells. The area under the receiver operating characteristic curve (AUROC) was 0.630 (p < 0.001) for serum MMP-7 in predicting perforation. When serum MMP-7 was combined with γ-glutamyl transferase (GGT), the AUROC increased to 0.706 (p < 0.001). Conclusions Serum MMP-7 was associated with biliary obstruction in CDCs. Patients with high serum MMP-7 were more likely to have severe liver damage and biliary injury, with higher incidences of liver fibrosis and perforation.

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Section: Discussionmentioning

confidence: 99%

“…Data were assessed for each patient [ 10 ]. The papilla of Vater located at the distal end of the descending duodenum was recognized as ectopic, whereas the papilla of Vater located at the descending duodenum was considered normal [ 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

Relationships of serum MMP-7 and clinical characteristics in choledochal cyst children

Yin,

Chen,

Zhou

et al. 2024

BMC Surg

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“…The variations of MDP can pose a high risk for certain biliary and pancreatic disorders, which can also result in difficulties when performing endoscopic retrograde cholangiopancreatography (ERCP) [ 9 , 10 ]. In pediatric patients, it has been reported that certain congenital biliary diseases, such as choledochal cyst (CC) and anomalous pancreaticobiliary junction (APBJ), are associated with a higher proportion of ectopic distal location of the papilla [ 11 , 12 ]. However, these studies were limited by small sample size and patient selection.…”

Section: Introductionmentioning

confidence: 99%

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

Zhang,

Shi,

et al. 2023

Gastroenterology Report

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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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The timing of minimally invasive surgery for prenatally diagnosed choledochal cysts

Pan,

Li,

Chen

et al. 2024

BMC Pediatr

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Objective There are no clear evidence-based recommendations concerning when patients with prenatally diagnosed choledochal cysts (CCs) should undergo surgery. This study was primarily designed to explore the proper timing of minimally invasive surgery for prenatally diagnosed CC patients. Methods Seventy-three patients with prenatally diagnosed CC were enrolled in this study and divided into 4 subgroups according to age at surgery (15 patients in the < 1 month group, 27 in the 1–2 months group, 14 in the 2–3 months group and 17 in the > 3 months group). Eighty-five healthy infants were recruited and divided into 4 age groups (29 in the < 1 month group, 20 in the 1–2 month group, 19 in the 2–3 month group and 17 in the > 3 month group). Preoperative data were collected and compared between CC patients and healthy controls in 4 age groups. Additionally, 73 patients were divided into laparoscopic and open groups to compare postoperative recovery indices and the occurrence of complications to determine the safety and feasibility of laparoscopic CC application in neonates and young infants. Results Twenty-one of 73 (28.8%) patients who were prenatally diagnosed with CCs experienced various clinical symptoms, and 15 of 21 (71.4%) patients experienced clinical symptoms less than 2 months after birth. No differences were found in alanine transaminase (ALT), aspartate transaminase (AST) or aspartate transaminase (APRI) levels between CC patients and controls at ≤ 1 month or 1–2 months of age (all p > 0.05), while higher levels were found in CC patients at 2–3 months or > 3 months of age (all p < 0.05). ALT, AST and DBIL levels 1 week after surgery were significantly lower than those before surgery in CC patients who underwent laparoscopic CC excision at > 2 months of age, while DBIL levels 1 week after surgery were also significantly lower than those before surgery in patients who underwent CC excision at ≤ 2 months of age. The initial oral feeding time in the laparoscopic surgery group was significantly earlier than that in the open surgery group for both CC patients who underwent CC excision at ≤ 2 months of age and those > 2 months of age (all p < 0.05). No differences were found in the rates of anastomotic leakage or stricture formation between the laparoscopic and open surgery groups at ≤ 2 months or > 2 months of age. Conclusion Most clinical symptoms attributed to CC occur less than 2 months after birth, while liver function and liver fibrosis may deteriorate after 2 months of age in patients with prenatally diagnosed CC. Laparoscopic surgery for CC in newborns and young infants (either less than or more than 2 months old) is safe and feasible and can shorten the initial oral feeding time without increasing complications such as postoperative anastomotic leakage or stricture. Thus, performing laparoscopic CC excisions within 2 months after birth in patients with prenatally diagnosed CC may be appropriate.

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Correlation of ectopic distal location of papilla of Vater and clinical characteristics in pediatric choledochal cysts

Cited by 3 publications

References 20 publications

Relationships of serum MMP-7 and clinical characteristics in choledochal cyst children

Relationships of serum MMP-7 and clinical characteristics in choledochal cyst children

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study

The timing of minimally invasive surgery for prenatally diagnosed choledochal cysts

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