Pancreas divisum: A risk factor for pancreaticobiliary tumors – an analysis of 1628 MR cholangiography examinations

Adıbelli, Zehra Hilal; Adatepe, Mustafa H.; Isayeva, Leyla; Esen, Özgür; Yıldırım, Mehmet

doi:10.1016/j.diii.2016.08.004

Cited by 14 publications

(16 citation statements)

References 25 publications

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“…Pancreas divisum is a common finding with a reported frequency of 3–13% in autopsy, MRCP and ERCP studies. 3, 6, 19–21 In clinical imaging studies using MRCP, pancreas divisum was detected in approximately 12% of cases, typically as incidental findings. 9 Onder at al .…”

Section: Discussionmentioning

confidence: 99%

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Adıbelli

Adatepe²,

İmamoğlu

et al. 2016

Radiology and Oncology

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BackgroundThe study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP).Patients and methodsWe retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study.ResultsAmong the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most commonly observed pancreatic duct configuration was Type 3 in 528 patients (45.6%) where 521 patients (45%) had Type 1 configuration.ConclusionsVertical course (p = 0.004) and Type 2 (p = 0.03) configuration of pancreatic duct were more frequent in females than males. There were no statistically significant differences between the gender for the other pancreatic duct variations such as pancreas divisium, ansa pancreatica and course types other than vertical course (p > 0.05 for all). Variants of pancreas divisum and normal pancreatic duct variants were not associated with morphologic findings of chronic pancreatitis by using the Cambridge classification system. The ansa pancreatica is a rare type of anatomical variation of the pancreatic duct, which might be considered as a predisposing factor to the onset of idiopathic pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Adıbelli

Adatepe²,

İmamoğlu

et al. 2016

Radiology and Oncology

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“…It has also been reported recently that there is a higher prevalence of pancreatic and biliary tumors in patients with PD than with a normal ductal system. (7.8% vs 3.5%)[30]. There have been reports of partial agenesis of the dorsal pancreas with PD with some debate as to whether the agenesis led to the PD or a consequence[14, 31].…”

Section: Associated Pancreatic-biliary Anomaliesmentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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Pancreas divisum, the most common congenital malformation of the pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of pancreas divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify pancreas divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.

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“…In pancreas divisum, the pancreatic ducts fail to properly fuse, 19,20 which can result in chronic pancreatitis 21 and increase the risk for pancreaticobiliary tumors. 22 Similarly, the luminal fusion of the collecting duct and nephrons is required for proper function of the kidney, and aberrant fusion can result in cases of diffuse renal dysplasia or hydronephrosis. 23 During the final stages of development of the avian lung, the terminally branched parabronchi that emerge from the anterior side of the organ undergo extensive fusion with those that emerge from the posterior side, thus closing the circuit that allows for unidirectional airflow.…”

Section: Introductionmentioning

confidence: 99%

Fusion of airways during avian lung development constitutes a novel mechanism for the formation of continuous lumena in multicellular epithelia

Palmer

Nelson

2020

Developmental Dynamics

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Background: During development of the avian lung, the initially terminally branched epithelial tree later forms a continuous network of airways. This occurs via a large-scale epithelial fusion event, wherein airways that originate proximally collide with those that originate distally to form one continuous lumen. Results: Here, we found that prior to fusion, the epithelium of the embryonic chicken lung undergoes a shape change to permit the initiation and extension of new branches which contain the cells that initiate contact. These changes in epithelial shape coincide with the differentiation of smooth muscle cells that wrap the airways. From these nascent epithelial branches, individual cells form cytoskeletal protrusions that extend toward and form a bridge with their target airway. Additional cells then join the fusion site, forming a bilayered epithelium. During this process, the basement membrane around the prefusion epithelium degrades and then reforms after fusion. The epithelial bilayer then undergoes apoptosis, clearing the path between the two lumens. Conclusions: The process of airway epithelial fusion in the developing chicken lung constitutes a novel mechanism for the generation of complex multicellular tubes and suggests a conserved role for smooth muscle in the shaping of airway epithelia.

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Pancreas divisum: A risk factor for pancreaticobiliary tumors – an analysis of 1628 MR cholangiography examinations

Abstract: The results of our study suggest that patients with pancreas divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.

Cited by 14 publications

References 25 publications

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Identification and management of pancreas divisum

Fusion of airways during avian lung development constitutes a novel mechanism for the formation of continuous lumena in multicellular epithelia

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