Thickened inner hypoechoic layer of the gallbladder wall in the diagnosis of anomalous pancreaticobiliary ductal union with endosonography
Background: An anomalous pancreaticobiliary ductal union (APBD) is a high-risk factor for biliary tract carcinoma, which often is not diagnosed before overt malignancy. The early detection of APBD is therefore clinically important. We evaluated the gallbladder wall in APBD patients with endoscopic u...
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| Veröffentlicht in: | Gastrointestinal endoscopy 1997-12, Vol.46 (6), p.520-526 |
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| creator | Tanno, Satoshi Obara, Takeshi Maguchi, Hiroyuki Mizukami, Yusuke Shudo, Ryushi Fujii, Tsuneshi Takahashi, Kuniyuki Nishino, Noriyuki Arisato, Satoshi Saitoh, Yusuke Ura, Hitoshi Kohgo, Yutaka |
| description | Background: An anomalous pancreaticobiliary ductal union (APBD) is a high-risk factor for biliary tract carcinoma, which often is not diagnosed before overt malignancy. The early detection of APBD is therefore clinically important. We evaluated the gallbladder wall in APBD patients with endoscopic ultrasonography.
Methods: Clinicopathologic features and ultrasonographic findings of the gallbladder in 33 consecutive patients with APBD between 1986 and 1995 were studied in relation to two subtypes of APBD, that is, undilated (
n = 17) and dilated (
n = 16). The gallbladder wall was evaluated with conventional ultrasonography and/or endoscopic ultrasonography. Histologic examinations of 25 resected gallbladders were made.
Results: Fourteen of the seventeen patients with undilated type APBD (82%) had diffuse thickened gallbladder wall of 4 mm or more, whereas 5 of the 16 with dilated type (31%) had this finding (
p < 0.01). The thickened gallbladder wall consisted sonographically of two layers: diffuse thickened inner hypoechoic layer and outer hyperechoic layer. Mucosal hyperplasia was histologically found in 8 of 9 cases (89%) with thickened inner hypoechoic layer on endoscopic ultrasonography. Mucosal hyperplasia was observed in 10 of 11 undilated type APBD cases (91%) in which cholecystectomy was performed. In addition, the presence of anomalous union was shown by endoscopic ultrasonography in 9 of 11 patients with undilated type APBD (82%) and all 7 of those with dilated type. The characteristic ultrasonographic pattern of diffuse thickened inner hypoechoic layer was observed exclusively in patients with mucosal hyperplasia of the gallbladder associated with APBD among 2085 endoscopic ultrasonography examinations performed during the study period.
Conclusions: Diffuse thickened inner hypoechoic layer of the gallbladder wall was frequently observed in APBD patients, especially those with the undilated type, on ultrasonography and/or endoscopic ultrasonography. This finding corresponded histologically to mucosal hyperplasia of the gallbladder mucosa. Thickened inner hypoechoic layer is a useful ultrasonographic sign that indicates mucosal hyperplasia of the gallbladder and, particularly, the possible coexistence of undilated type APBD before the appearance of overt malignancy. (Gastrointest Endosc 1997;46:520-6.) |
| doi_str_mv | 10.1016/S0016-5107(97)70007-5 |
| format | Article |
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Methods: Clinicopathologic features and ultrasonographic findings of the gallbladder in 33 consecutive patients with APBD between 1986 and 1995 were studied in relation to two subtypes of APBD, that is, undilated (
n = 17) and dilated (
n = 16). The gallbladder wall was evaluated with conventional ultrasonography and/or endoscopic ultrasonography. Histologic examinations of 25 resected gallbladders were made.
Results: Fourteen of the seventeen patients with undilated type APBD (82%) had diffuse thickened gallbladder wall of 4 mm or more, whereas 5 of the 16 with dilated type (31%) had this finding (
p < 0.01). The thickened gallbladder wall consisted sonographically of two layers: diffuse thickened inner hypoechoic layer and outer hyperechoic layer. Mucosal hyperplasia was histologically found in 8 of 9 cases (89%) with thickened inner hypoechoic layer on endoscopic ultrasonography. Mucosal hyperplasia was observed in 10 of 11 undilated type APBD cases (91%) in which cholecystectomy was performed. In addition, the presence of anomalous union was shown by endoscopic ultrasonography in 9 of 11 patients with undilated type APBD (82%) and all 7 of those with dilated type. The characteristic ultrasonographic pattern of diffuse thickened inner hypoechoic layer was observed exclusively in patients with mucosal hyperplasia of the gallbladder associated with APBD among 2085 endoscopic ultrasonography examinations performed during the study period.
Conclusions: Diffuse thickened inner hypoechoic layer of the gallbladder wall was frequently observed in APBD patients, especially those with the undilated type, on ultrasonography and/or endoscopic ultrasonography. This finding corresponded histologically to mucosal hyperplasia of the gallbladder mucosa. Thickened inner hypoechoic layer is a useful ultrasonographic sign that indicates mucosal hyperplasia of the gallbladder and, particularly, the possible coexistence of undilated type APBD before the appearance of overt malignancy. (Gastrointest Endosc 1997;46:520-6.)</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/S0016-5107(97)70007-5</identifier><identifier>PMID: 9434219</identifier><identifier>CODEN: GAENBQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Biliary Tract Neoplasms - epidemiology ; Biological and medical sciences ; Common Bile Duct - abnormalities ; Congenital Abnormalities - diagnostic imaging ; Congenital Abnormalities - epidemiology ; Digestive system. Abdomen ; Endosonography ; Female ; Gallbladder - diagnostic imaging ; Gallbladder - pathology ; Humans ; Hyperplasia ; Incidence ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Pancreatic Ducts - abnormalities ; Retrospective Studies ; Risk Factors ; Ultrasonic investigative techniques</subject><ispartof>Gastrointestinal endoscopy, 1997-12, Vol.46 (6), p.520-526</ispartof><rights>1997 American Society for Gastrointestinal Endoscopy</rights><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-25b1a16b6f62a03778a5f332a555ab9566d913746893cf9fd679947bf1985c0d3</citedby><cites>FETCH-LOGICAL-c389t-25b1a16b6f62a03778a5f332a555ab9566d913746893cf9fd679947bf1985c0d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0016-5107(97)70007-5$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2093174$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9434219$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tanno, Satoshi</creatorcontrib><creatorcontrib>Obara, Takeshi</creatorcontrib><creatorcontrib>Maguchi, Hiroyuki</creatorcontrib><creatorcontrib>Mizukami, Yusuke</creatorcontrib><creatorcontrib>Shudo, Ryushi</creatorcontrib><creatorcontrib>Fujii, Tsuneshi</creatorcontrib><creatorcontrib>Takahashi, Kuniyuki</creatorcontrib><creatorcontrib>Nishino, Noriyuki</creatorcontrib><creatorcontrib>Arisato, Satoshi</creatorcontrib><creatorcontrib>Saitoh, Yusuke</creatorcontrib><creatorcontrib>Ura, Hitoshi</creatorcontrib><creatorcontrib>Kohgo, Yutaka</creatorcontrib><title>Thickened inner hypoechoic layer of the gallbladder wall in the diagnosis of anomalous pancreaticobiliary ductal union with endosonography</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background: An anomalous pancreaticobiliary ductal union (APBD) is a high-risk factor for biliary tract carcinoma, which often is not diagnosed before overt malignancy. The early detection of APBD is therefore clinically important. We evaluated the gallbladder wall in APBD patients with endoscopic ultrasonography.
Methods: Clinicopathologic features and ultrasonographic findings of the gallbladder in 33 consecutive patients with APBD between 1986 and 1995 were studied in relation to two subtypes of APBD, that is, undilated (
n = 17) and dilated (
n = 16). The gallbladder wall was evaluated with conventional ultrasonography and/or endoscopic ultrasonography. Histologic examinations of 25 resected gallbladders were made.
Results: Fourteen of the seventeen patients with undilated type APBD (82%) had diffuse thickened gallbladder wall of 4 mm or more, whereas 5 of the 16 with dilated type (31%) had this finding (
p < 0.01). The thickened gallbladder wall consisted sonographically of two layers: diffuse thickened inner hypoechoic layer and outer hyperechoic layer. Mucosal hyperplasia was histologically found in 8 of 9 cases (89%) with thickened inner hypoechoic layer on endoscopic ultrasonography. Mucosal hyperplasia was observed in 10 of 11 undilated type APBD cases (91%) in which cholecystectomy was performed. In addition, the presence of anomalous union was shown by endoscopic ultrasonography in 9 of 11 patients with undilated type APBD (82%) and all 7 of those with dilated type. The characteristic ultrasonographic pattern of diffuse thickened inner hypoechoic layer was observed exclusively in patients with mucosal hyperplasia of the gallbladder associated with APBD among 2085 endoscopic ultrasonography examinations performed during the study period.
Conclusions: Diffuse thickened inner hypoechoic layer of the gallbladder wall was frequently observed in APBD patients, especially those with the undilated type, on ultrasonography and/or endoscopic ultrasonography. This finding corresponded histologically to mucosal hyperplasia of the gallbladder mucosa. Thickened inner hypoechoic layer is a useful ultrasonographic sign that indicates mucosal hyperplasia of the gallbladder and, particularly, the possible coexistence of undilated type APBD before the appearance of overt malignancy. (Gastrointest Endosc 1997;46:520-6.)</description><subject>Adult</subject><subject>Aged</subject><subject>Biliary Tract Neoplasms - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Common Bile Duct - abnormalities</subject><subject>Congenital Abnormalities - diagnostic imaging</subject><subject>Congenital Abnormalities - epidemiology</subject><subject>Digestive system. Abdomen</subject><subject>Endosonography</subject><subject>Female</subject><subject>Gallbladder - diagnostic imaging</subject><subject>Gallbladder - pathology</subject><subject>Humans</subject><subject>Hyperplasia</subject><subject>Incidence</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pancreatic Ducts - abnormalities</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Ultrasonic investigative techniques</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc2OFCEUhYnRjO3oI0zCwhhdlEJRQLEyZuJfMokLxzW5BVQXSkMJVU76FXxq6Z_01g2Qc78Ll3MQuqHkLSVUvPtO6tpwSuRrJd9IQohs-CO0oUTJRkipHqPNBXmKnpXyszJ9y-gVulId61qqNujv_eTNLxedxT5Gl_G0n5MzU_IGB9hXIY14mRzeQghDAGur9FDPFT_q1sM2puLLAYSYdhDSWvAM0WQHizdp8MFD3mO7mgUCXqNPET_4ZcIu2lRSTNsM87R_jp6MEIp7cd6v0Y9PH-9vvzR33z5_vf1w1xjWq6Vp-UCBikGMogXCpOyBj4y1wDmHQXEhrKJMdqJXzIxqtEIq1clhpKrnhlh2jV6d7p1z-r26suidL8aFANHV0bVUnNKuFRXkJ9DkVEp2o56z39WvaEr0IQN9zEAfDNZK6mMGmte-m_MD67Bz9tJ1Nr3WX57rUAyEMVevfLlgLVGMyq5i70-Yq2b88S7rYryLxlmfnVm0Tf4_g_wDsZalcg</recordid><startdate>19971201</startdate><enddate>19971201</enddate><creator>Tanno, Satoshi</creator><creator>Obara, Takeshi</creator><creator>Maguchi, Hiroyuki</creator><creator>Mizukami, Yusuke</creator><creator>Shudo, Ryushi</creator><creator>Fujii, Tsuneshi</creator><creator>Takahashi, Kuniyuki</creator><creator>Nishino, Noriyuki</creator><creator>Arisato, Satoshi</creator><creator>Saitoh, Yusuke</creator><creator>Ura, Hitoshi</creator><creator>Kohgo, Yutaka</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19971201</creationdate><title>Thickened inner hypoechoic layer of the gallbladder wall in the diagnosis of anomalous pancreaticobiliary ductal union with endosonography</title><author>Tanno, Satoshi ; Obara, Takeshi ; Maguchi, Hiroyuki ; Mizukami, Yusuke ; Shudo, Ryushi ; Fujii, Tsuneshi ; Takahashi, Kuniyuki ; Nishino, Noriyuki ; Arisato, Satoshi ; Saitoh, Yusuke ; Ura, Hitoshi ; Kohgo, Yutaka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c389t-25b1a16b6f62a03778a5f332a555ab9566d913746893cf9fd679947bf1985c0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biliary Tract Neoplasms - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Common Bile Duct - abnormalities</topic><topic>Congenital Abnormalities - diagnostic imaging</topic><topic>Congenital Abnormalities - epidemiology</topic><topic>Digestive system. Abdomen</topic><topic>Endosonography</topic><topic>Female</topic><topic>Gallbladder - diagnostic imaging</topic><topic>Gallbladder - pathology</topic><topic>Humans</topic><topic>Hyperplasia</topic><topic>Incidence</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pancreatic Ducts - abnormalities</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Ultrasonic investigative techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tanno, Satoshi</creatorcontrib><creatorcontrib>Obara, Takeshi</creatorcontrib><creatorcontrib>Maguchi, Hiroyuki</creatorcontrib><creatorcontrib>Mizukami, Yusuke</creatorcontrib><creatorcontrib>Shudo, Ryushi</creatorcontrib><creatorcontrib>Fujii, Tsuneshi</creatorcontrib><creatorcontrib>Takahashi, Kuniyuki</creatorcontrib><creatorcontrib>Nishino, Noriyuki</creatorcontrib><creatorcontrib>Arisato, Satoshi</creatorcontrib><creatorcontrib>Saitoh, Yusuke</creatorcontrib><creatorcontrib>Ura, Hitoshi</creatorcontrib><creatorcontrib>Kohgo, Yutaka</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tanno, Satoshi</au><au>Obara, Takeshi</au><au>Maguchi, Hiroyuki</au><au>Mizukami, Yusuke</au><au>Shudo, Ryushi</au><au>Fujii, Tsuneshi</au><au>Takahashi, Kuniyuki</au><au>Nishino, Noriyuki</au><au>Arisato, Satoshi</au><au>Saitoh, Yusuke</au><au>Ura, Hitoshi</au><au>Kohgo, Yutaka</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thickened inner hypoechoic layer of the gallbladder wall in the diagnosis of anomalous pancreaticobiliary ductal union with endosonography</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>1997-12-01</date><risdate>1997</risdate><volume>46</volume><issue>6</issue><spage>520</spage><epage>526</epage><pages>520-526</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><coden>GAENBQ</coden><abstract>Background: An anomalous pancreaticobiliary ductal union (APBD) is a high-risk factor for biliary tract carcinoma, which often is not diagnosed before overt malignancy. The early detection of APBD is therefore clinically important. We evaluated the gallbladder wall in APBD patients with endoscopic ultrasonography.
Methods: Clinicopathologic features and ultrasonographic findings of the gallbladder in 33 consecutive patients with APBD between 1986 and 1995 were studied in relation to two subtypes of APBD, that is, undilated (
n = 17) and dilated (
n = 16). The gallbladder wall was evaluated with conventional ultrasonography and/or endoscopic ultrasonography. Histologic examinations of 25 resected gallbladders were made.
Results: Fourteen of the seventeen patients with undilated type APBD (82%) had diffuse thickened gallbladder wall of 4 mm or more, whereas 5 of the 16 with dilated type (31%) had this finding (
p < 0.01). The thickened gallbladder wall consisted sonographically of two layers: diffuse thickened inner hypoechoic layer and outer hyperechoic layer. Mucosal hyperplasia was histologically found in 8 of 9 cases (89%) with thickened inner hypoechoic layer on endoscopic ultrasonography. Mucosal hyperplasia was observed in 10 of 11 undilated type APBD cases (91%) in which cholecystectomy was performed. In addition, the presence of anomalous union was shown by endoscopic ultrasonography in 9 of 11 patients with undilated type APBD (82%) and all 7 of those with dilated type. The characteristic ultrasonographic pattern of diffuse thickened inner hypoechoic layer was observed exclusively in patients with mucosal hyperplasia of the gallbladder associated with APBD among 2085 endoscopic ultrasonography examinations performed during the study period.
Conclusions: Diffuse thickened inner hypoechoic layer of the gallbladder wall was frequently observed in APBD patients, especially those with the undilated type, on ultrasonography and/or endoscopic ultrasonography. This finding corresponded histologically to mucosal hyperplasia of the gallbladder mucosa. Thickened inner hypoechoic layer is a useful ultrasonographic sign that indicates mucosal hyperplasia of the gallbladder and, particularly, the possible coexistence of undilated type APBD before the appearance of overt malignancy. (Gastrointest Endosc 1997;46:520-6.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>9434219</pmid><doi>10.1016/S0016-5107(97)70007-5</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Biliary Tract Neoplasms - epidemiology Biological and medical sciences Common Bile Duct - abnormalities Congenital Abnormalities - diagnostic imaging Congenital Abnormalities - epidemiology Digestive system. Abdomen Endosonography Female Gallbladder - diagnostic imaging Gallbladder - pathology Humans Hyperplasia Incidence Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Pancreatic Ducts - abnormalities Retrospective Studies Risk Factors Ultrasonic investigative techniques |
| title | Thickened inner hypoechoic layer of the gallbladder wall in the diagnosis of anomalous pancreaticobiliary ductal union with endosonography |
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