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A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation

BACKGROUND: Knowledge regarding biliary anatomy and its variations, including the cystic duct (CD), is important in the pre-surgical setting and for predicting biliary diseases. However, no large series has focused on CD evaluation using a quantitative analysis. The primary aim of this prospective s...

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Autores principales: Renzulli, Matteo, Brocchi, Stefano, Marasco, Giovanni, Spinelli, Daniele, Balacchi, Caterina, Barakat, Massimo, Pettinari, Irene, Golfieri, Rita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484130/
https://www.ncbi.nlm.nih.gov/pubmed/33269458
http://dx.doi.org/10.1007/s11605-020-04852-8
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author Renzulli, Matteo
Brocchi, Stefano
Marasco, Giovanni
Spinelli, Daniele
Balacchi, Caterina
Barakat, Massimo
Pettinari, Irene
Golfieri, Rita
author_facet Renzulli, Matteo
Brocchi, Stefano
Marasco, Giovanni
Spinelli, Daniele
Balacchi, Caterina
Barakat, Massimo
Pettinari, Irene
Golfieri, Rita
author_sort Renzulli, Matteo
collection PubMed
description BACKGROUND: Knowledge regarding biliary anatomy and its variations, including the cystic duct (CD), is important in the pre-surgical setting and for predicting biliary diseases. However, no large series has focused on CD evaluation using a quantitative analysis. The primary aim of this prospective study was to create a ‘taxonomic’ classification of CD anatomy in a large cohort of subjects who underwent magnetic resonance cholangiopancreatography (MRCP). The secondary aim was to evaluate the correlations between extrahepatic bile duct (EHBD) variants and biliary diseases. METHODS: We enrolled patients who underwent MRCP for different clinical indications from January 2017 to May 2019. Demographical, anatomical and clinical data were evaluated using statistical analyses, as appropriate. The anatomical assessment of EHBD was performed using the standard classification for CD in low, medium, and high insertions, and the lengths of CD to the duodenal papilla (DP), and EHBD was determined to conduct a new quantitative analysis. RESULTS: The final study population comprised 1004 subjects. A new classification for EHBD as per the percentile distribution of the ratio CDDP/EHBD was designed, and the following categories were obtained: type 1 (below the 25th percentile) for CDDP/EHBD ratio ≤ 50%; type 2 (25th to 75th percentile) for CDDP/EHBD ratio 51–75% and type 3 (above the 75th percentiles) for CDDP/EHBD ratio > 75%. Type 1 of the new classification of CD implantation was significantly superior in terms of the detection of low, medial and intra-pancreatic CD that was significantly correlated with a high risk of choledochal lithiasis in comparison with the standard classification (P < 0.001). CONCLUSIONS: The new classification of CD implantation enables identification of the vast majority of intra-pancreatic CDs that are correlated with a high risk of choledochal lithiasis in a single category (type 1) that is easy to identify using imaging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-020-04852-8.
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spelling pubmed-84841302021-10-08 A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation Renzulli, Matteo Brocchi, Stefano Marasco, Giovanni Spinelli, Daniele Balacchi, Caterina Barakat, Massimo Pettinari, Irene Golfieri, Rita J Gastrointest Surg Original Article BACKGROUND: Knowledge regarding biliary anatomy and its variations, including the cystic duct (CD), is important in the pre-surgical setting and for predicting biliary diseases. However, no large series has focused on CD evaluation using a quantitative analysis. The primary aim of this prospective study was to create a ‘taxonomic’ classification of CD anatomy in a large cohort of subjects who underwent magnetic resonance cholangiopancreatography (MRCP). The secondary aim was to evaluate the correlations between extrahepatic bile duct (EHBD) variants and biliary diseases. METHODS: We enrolled patients who underwent MRCP for different clinical indications from January 2017 to May 2019. Demographical, anatomical and clinical data were evaluated using statistical analyses, as appropriate. The anatomical assessment of EHBD was performed using the standard classification for CD in low, medium, and high insertions, and the lengths of CD to the duodenal papilla (DP), and EHBD was determined to conduct a new quantitative analysis. RESULTS: The final study population comprised 1004 subjects. A new classification for EHBD as per the percentile distribution of the ratio CDDP/EHBD was designed, and the following categories were obtained: type 1 (below the 25th percentile) for CDDP/EHBD ratio ≤ 50%; type 2 (25th to 75th percentile) for CDDP/EHBD ratio 51–75% and type 3 (above the 75th percentiles) for CDDP/EHBD ratio > 75%. Type 1 of the new classification of CD implantation was significantly superior in terms of the detection of low, medial and intra-pancreatic CD that was significantly correlated with a high risk of choledochal lithiasis in comparison with the standard classification (P < 0.001). CONCLUSIONS: The new classification of CD implantation enables identification of the vast majority of intra-pancreatic CDs that are correlated with a high risk of choledochal lithiasis in a single category (type 1) that is easy to identify using imaging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-020-04852-8. Springer US 2020-12-02 2021 /pmc/articles/PMC8484130/ /pubmed/33269458 http://dx.doi.org/10.1007/s11605-020-04852-8 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Renzulli, Matteo
Brocchi, Stefano
Marasco, Giovanni
Spinelli, Daniele
Balacchi, Caterina
Barakat, Massimo
Pettinari, Irene
Golfieri, Rita
A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title_full A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title_fullStr A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title_full_unstemmed A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title_short A New Quantitative Classification of the Extrahepatic Biliary Tract Related to Cystic Duct Implantation
title_sort new quantitative classification of the extrahepatic biliary tract related to cystic duct implantation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484130/
https://www.ncbi.nlm.nih.gov/pubmed/33269458
http://dx.doi.org/10.1007/s11605-020-04852-8
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