无先天性胆管囊性扩张型的胰胆管汇流异常与胆胰疾病的关系

目的研究无先天性胆管囊性扩张型的胰胆管汇流异常(APBJ)及其与胆胰疾病的关系.方法分析1995年1月～ 2002年1月间逆行胰胆管造影(ERCP)、术中胆道造影(IOC)、磁共振胰胆管造影(MRCP)等影像学检查的2 150例胆胰疾病中的52例无先天性胆管囊性扩张型APBJ及其与胆胰疾病的关系.结果本组APBJ的发生率为2.4%,APBJ的检查发现率为ERCP 2.9%、IOC 2.4%、MRCP 2.0%.在52例无先天性胆管囊性扩张型APBJ中有P-C型(胰管注入胆总管)32例、C-P型(胆总管汇入胰管)20例.胆囊上皮增生的发生率为51.9%,胆囊结石的发生率为73.1%,胆囊息肉样病变的发生率为26.9%,急性胰腺炎的发生率为34.6%.结论 APBJ与胆胰疾病关系密切,无先天性胆管囊性扩张型APBJ的胆囊上皮增生和胆囊息肉样病变发生率高,是胆囊癌发生的一个高危因素,对此类型APBJ病人主张预防性胆囊切除.APBJ是胰腺炎发病的一个重要因素,C-P型APBJ的胰腺炎发生率高,在反复胰腺炎发作而无明显原因时,应考虑有APBJ的存在.     

胰腺癌的内镜逆行胰胆管造影诊断

应用内镜逆行胰胆管造影(ERCP)诊断胆胰管疾病已有30多年的历史，造影成功率可达85％～95％．已成为诊断胆胰管结石、胆管良恶性狭窄和畸形、胆囊和胆囊管病变等胆胰管疾病和鉴别诊断疑难性腹痛的重要手段之一。ERCP对梗阻性黄疸、十二指肠乳头肿瘤和胰管异常的鉴别诊断尤为有利,检查中收集的胆汁和胰液还可作细菌培养和细胞学检查。磁共振胰胆管造影(MRCP)为无创伤性检查，诊断较为准确，有可能取代诊断性ERCP，但并不能取代ERCP在治疗方面的作用。     

胆胰疾病磁共振误诊及与ERCP结果比较分析

磁共振胰胆管显影术（MRCP）作为一种无创性诊断技术，其临床应用日趋增多，而经内镜逆行胰胆管造影（ERCP）作为胆胰系疾病的诊断金标准已在临床应用多年。为了评价MRCP和ERCP对胆胰系疾病的诊断价值，我们分析了56例胆胰疾病病例磁共振胰胆管造影（MRCP）误诊情况及与ERCP结果进行比较，报道如下。     

ERCP和MRCP对胆管微小结石诊治价值比较

目的 评价经内镜逆行胰胆管造影(ERCP)和磁共振胆胰管成像(MRCP)对胆管微小结石相关性疾病的诊治价值.方法 收集我院56例急性胆源性胰腺炎和16例胆道结石梗阻患者,入选患者同时完成MRCP、ERCP检查治疗,所发现胆胰结石直径均小于3 mm,分析比较两种方法 对胆管微小结石的诊断价值.结果 68例患者MRCP明确提示存在胆总管末端狭窄或胆胰管扩张,占94.4%:61例患者ERCP检查可直接发现微小结石,占84.7%:8例患者通过EST切开及取石球囊取石才发现微小结石或泥沙样结石.结论 MRCP作为胆胰疾病的一种无创检查而具有重要的应用前景:ERCP对于微小结石导致的胆胰疾病具有重要诊断意义和治疗价值.     

磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究

目的：比较直接胰胆管造影（ERCP和PTC）和磁共振胰胆管成像（MRCP）对胆胰疾病的诊断价住材料。方法：临床怀疑胆胰系统疾病63例。每例先行MRCP，使用Siemens1.5TVision Plus磁共振扫仪进行检查，检查前4小时禁食、水，检查时采用自控阵表面线圈和屏气技术于呼气未以HASTE序列：T2加权像行多层扫描采集数据，原始数据作三维重建。在此后24小时内行ERCP。影像科医师和内镜医师分别报告自己所见结果，待研究结束后进行统一对比分析，分析时以ERCP或PTC结果为参照标准，结果63例行ERCP中，成功率88.9％（56/63），7例ERCP失败（11.1％）改行PTC检查成功；所有MRCP均获得成功，成功率100％；MRCP的灵敏度98.2％、特异度83.3％、误诊率16.7％、漏诊率1.8％。MRCP和ERCP（或PTC）总符合率85.71％，其中在胆系结石及胆管肿瘤分别为100％和92.86％，乳头部病变为70.59％（12/17），在慢性胰腺炎和肝吸虫的诊断符合率分别为3/3和66.67％。（例ERCP，术后并发胰腺炎5例、肾周脓肿1例（为B-Ⅱ术后），并发症发生率9.52％（6/63）；MRCP无并发症。结论：对胆管内疾病，MRCP可达到ERCP的单纯诊断水平，而对乳头部的病变（尤其是小病变）和肝吸虫，MRCP却无法与ERCP相比拟。对不能耐受ERCP及有ERCP禁忌症，MRCP是较好的选择。MRCP的最大不便，在于不能同时进行治疗。     

胆管囊肿的MRI诊断

胆管囊肿非常少见，其以远端胆总管囊柱状扩张为特点，以腹痛、腹部包块、黄疸为临床主症，部分或完全胆管或胰管阻塞可引起胆汁淤滞、胆管炎、急慢性胆囊炎或胰腺炎。以往对其诊断主要靠超声（US）、计算机体层摄影（CT）、内窥镜逆行胆胰管造影（ERCP）、光电子发射体层摄影（ECT）。近来随着EUS、CT胆管造影、磁共振成像（MRI）＋磁共振胆胰管造影（MRCP）的应用。发现和报告增多。我院自1990～2000年共15例先天性胆管囊肿患者，得以手术和病理证实，均经MRI＋MRCP诊断。本文重点就其MRI＋MRCP的影像学特点和胆管囊肿的形成机制加以探讨。     

磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究

目的 比较直接胰胆管造影（ERCP和PTC）和磁共振胰胆管成像（MRCP）对胆胰疾病的诊断价值。方法 临床怀疑胆胰系疾病63例。每例先行MRCP,在此后24h内行ERCP。影像科和内镜医师分别报告自己所见结果,待研究结束后,以ERCP或PTC为参照标准统一对比分析。结果 63例行ERCP中,成功率为88.9%（56/63例）,7例ERCP失败者改行PTC检查成功;所有MRCP均获成功,成功率为100.0%;MRCP的灵敏度为98.2%、特异度83.3%、误诊率为16.7%、漏诊率为1.8%。MRCP和ERCP（或PTC）总符合率85.7%,其中在胆系结石及胆管肿瘤分别为100.0%和92.9%,乳头病病变为70.6%（12/17例）,在慢性胰腺炎和肝吸虫的诊断符合率分别为3/3和66.7%。63例ERCP者,术后并发胰腺炎5例、肾周脓肿1例（为B-Ⅱ术后）,并发症发生率为9.5%（6/63例）;而MRCP无并发症发生。结论 对胆管内疾病,MRCP可达到ERCP的单纯诊断水平,而对乳头部病变（尤其是小病变）和肝吸虫,MRCP却无法与ERCP相比拟。对不能耐受ERCP及禁忌症者,MRCP是较好的选择。MRCP的最大不便在于不能同时进行治疗。     

磁共振胰胆管水成像与内镜下逆行胰胆管造影术临床应用的对比研究

目的通过磁共振胰胆管水成像（MRCP）与内镜下逆行胰胆管造影术（ERCP）对胆胰疾病诊断的对比研究,为临床更好地选择诊治方案提供依据。方法回顾性分析120例行ERCP和（或）MRCP检查并经手术、病理等证实为胆胰疾病患者的临床资料。结果 MRCP和ERCP对胆道结石和胆管癌诊断的总符合率比较,无统计学差异（P均〉0.05）,对壶腹癌、慢性胰腺炎、胆囊切除术后胆汁漏或梗黄诊断符合率比较,差异均有统计学意义（P〈0.05）。ERCP有较好的治疗作用。结论 MRCP与ERCP各有优势,可以互相补充,根据胆胰疾病患者的临床表现、检查目的及治疗手段对两者的合理选择至关重要。     

预切开在ERCP诊疗Ⅰ型胰胆合流异常中的应用

胰胆管合流异常(pancreaticobiliary maljunction,PBM)是一种罕见的胆胰系先天性疾病,目前诊断主要依靠逆行胰胆管造影(ERCP),但Ⅰ型胰胆合流异常患者在ERCP操作中常规选择性胆管插管往往十分困难.本研究对Ⅰ型PBM患者采用胰管预切开和(或)开窗预切开的方法成功完成胆管插管,使ERCP成功率达100％,现报道如下.     

两种胆胰管造影方法临床应用价值的荟萃分析

目的评价内镜下逆行胰胆管造影术（ERCP）和磁共振胰胆管造影术（MRCP）在具有可疑胆胰疾病患者中的应用价值。方法通过MEDLINE、EMBASE等数据库检索国内外已发表和未发表的相关文献。选择针对具有可疑胆胰疾病患者,使用ERCP和MRCP两种方法进行比较的前瞻性研究。由2位评价者分别按以上检索策略收集资料,按选择标准人选,主要对两种检查方法的敏感性和特异性进行荟萃分析。结果ERCP和MRCP诊断胆总管结石、胆胰管狭窄、胆胰系统恶性疾病的敏感性差异无统计学意义。两者对上述疾病诊断的特异性方面,仅在诊断胰胆管狭窄时,ERCP高于MRCP,OR为6．17,95％CI为1,35～20．24,P=0．02。对于总体胆胰系统疾病的诊断,ERCP的敏感性和特异性均优于MRCP,OR分别为1．72和4．05.95％CI分别为1．04～2．85和1．32．12．42,P值分别为0．04及0．01。结论在诊断胆胰系统疾病时,总体敏感性和特异性都是ERCP优于MRCP。临床医生可以根据患者耐受程度和价效分析进行对ERCP和MRCP的取舍决策。     

Magnetic resonance cholangiopancreatography study of pancreaticobiliary maljunction and pancreaticobiliary diseases

AIM:To discuss the imaging anatomy about pancreaticobiliary ductal union,occurrence rate of pancreaticobiliary maljunction(PBM)and associated diseases in a Chinese population by using magnetic resonance cholangiopancreatography(MRCP).METHODS:Data were collected from 694 patients who underwent MRCP from January 2010 to December2012.Three hundred and ninety-three patients were male and 301 patients were female.The age range was16-92 years old and the average age was 51.8 years.The recruitment indication of all cases was patients who had clinical symptoms,such as abdominal pain,jaundice,nausea and vomiting,which thus were clinically suspected as relative pancreaticobiliary diseases.All cases were examined by MRCP using single-shot fast spin-echo sequences.In order to obtain MRCP images,the maximum intensity projection was used.RESULTS:According to the anatomy of pancreaticobiliary ductal union based on our analysis of MRCP images,all cases were classified into normal type and abnormal type according to the position of pancreaticobiliary ductal union.The abnormal type could be further divided into P-B type,B-P type and the duodenum type.By analyzing the incidence of biliary stone and inflammation,pancreatitis,biliary duct tumors and pancreatic tumors between normal and abnormal types,significant differences existed.The abnormal group was more likely to suffer from pancreaticobiliary diseases.Comparing three different types of PBM that were associated with pancreaticobiliary diseases by using Fisher’s method,the result showed that there was no significant difference in the incidence of biliary stones,cholecystitis and pancreatic tumors.The incidence of pancreatitis in B-P type and P-B type was higher than that in duodenum type;the incidence of biliary duct tumor in B-P type was higher than that in P-B type;the incidence of biliary duct tumor in duodenum type was lower than that in P-B type.The incidence of congenital choledochus dilatation in normal type and abnormal type was similar,and there was no significant difference between the two types.CONCLUSION:Types of PBM are closely related to the occurrence of pancreaticobiliary diseases.MRCP has important clinical value in the early diagnosis and preventive treatment of pancreaticobiliary diseases.     

胰胆管扩张的MRCP表现对胰腺癌和慢性胰腺炎的诊断意义

目的 研究胰胆管扩张对胰腺癌和慢性胰腺炎的诊断价值。方法 回顾性分析45例胰腺癌和41例慢性胰腺炎的MRCP资料。结果 胰腺癌组的MRCP主要特征包括：(1)胰管扩张多呈管腔光滑，明显扩张，并多在胰头肿块处截断(26例，占74．3％)；(2)扩张的胆总管多呈突然截断(26例，占89．7％)；(3)双管征(28例，占62．2％)。慢性胰腺炎组的MRCP主要特征：(1)胰管扩张多呈粗细不均的不规则型，并贯通病变(18例，占60．0％)，部分可见胰管结石(6例，占14．6％)；(2)扩张的胆总管由上至下逐渐变细(18例，占90．0％)。结论 胰胆管MRCP表现的形态特征对胰腺癌和慢性胰腺炎的诊断有鉴别意义。     

Pancreatitis associated with pancreaticobiliary maljunction

BACKGROUND/AIMS: Pancreaticobiliary maljunction is a rare anomaly, but causes various pathological conditions in the biliary tract and the pancreas. This study aims at clarifying the features of pancreatitis associated with pancreaticobiliary maljunction. METHODOLOGY: A total of 100 patients with pancreaticobiliary maljunction were reviewed. Clinical findings and cholangiopancreatographic results in patients with acute or chronic pancreatitis associated with pancreaticobiliary maljunction were analyzed. RESULTS: Of 100 patients, 14 had pancreatic disorders: acute pancreatitis (n = 3), chronic pancreatitis (n = 5), hyperamylasemia (n = 4), and pancreatic carcinoma (n = 2). The acute pancreatitis was mild (n = 3) and relapsing (n = 2). In patients with chronic pancreatitis, pancreatic stones (n = 2) and radiolucent protein plugs (n = 2) were detected only in the dilated common channel or in the main pancreatic duct near the common channel. Two patients received cyst-duodenostomy in the infant developed chronic pancreatitis 11 and 27 years later. CONCLUSIONS: Acute or chronic pancreatitis was sometimes associated with pancreaticobiliary maljunction. These pancreatitis cases showed different clinical and pancreatographic findings from others. These differences might be due to the peculiar mechanism that they were induced by bile reflux into the pancreatic duct via the anomalous connection.     

Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer

BACKGROUND/AIMS: Anomalous pancreaticobiliary junction is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between anomalous pancreaticobiliary junction, especially if it is not associated with common bile duct dilatation, and gallbladder carcinoma, we retrospectively reviewed data of 126 patients with gallbladder carcinoma. METHODOLOGY: All these patients had undergone direct cholangiography either by endoscopic retrograde cholangiopancreaticography or percutaneous transhepatic cholangiography. RESULTS: Among 126 patients with gallbladder cancer, 23 patients (18.3%) exhibited anomalous pancreaticobiliary junction. Patients with anomalous pancreaticobiliary junction were younger (mean age: 54 +/- 9.1 years) than patients without anomalous pancreaticobiliary junction (mean age: 65 +/- 9.7 years). The incidence of gallstones in patients with anomalous pancreaticobiliary junction (17%) was significantly lower than in those without this anomaly (64%) (P < 0.01). Among the 23 patients with anomalous pancreaticobiliary junction, 12 patients (52%) had no bile duct dilatation and, 11 patients (48%) had bile duct dilatation in the form of fusiform or cylindrical dilatation. However, no cases with severe cystic dilatation were found. Patients of anomalous pancreaticobiliary junction without common bile duct dilatation had more advanced disease and poor prognosis than those with common bile duct dilatation. CONCLUSIONS: The present study revealed that gallbladder cancer in the patients of anomalous pancreaticobiliary junction without common bile duct dilatation was diagnosed at advanced stage and the prognosis was very poor. Therefore, if a minor abnormality is detected in the wall of acalculous gallbladder on ultrasonography, direct cholangiography should be done to exclude this anomaly.     

The presence of a common channel and associated pancreaticobiliary diseases: A prospective ERCP study

BACKGROUND: There are few endoscopic retrograde cholangiographic studies dealing with the relationship between the presence of a common channel and associated pancreaticobiliary diseases. AIMS: To endoscopically determine the incidence of common channels and assess whether the anatomy of the pancreaticobiliary ductal drainage into the duodenum has any bearing on pancreaticobiliary diseases. PATIENTS AND METHODS: We prospectively examined a common channel formation in 354 endoscopic retrograde cholangiographic cases. Cases with a common channel were divided into three groups: pancreaticobiliary maljunction, high confluence of pancreaticobiliary ducts with a common channel > or =6 mm in which the communication was occluded with the sphincter contraction, and common channel < or =5 mm in length. RESULTS: A common channel was observed in 131 cases (37.0%) including 11 with pancreaticobiliary maljunction and 13 with high confluence of pancreaticobiliary ducts. In cases with a common channel, the incidences of associated gallbladder carcinoma and acute pancreatitis were both 11.5%, which were significantly higher than 1.8% and 4.9% seen in cases without a common channel. In pancreaticobiliary maljunction cases, incidence of associated gallbladder carcinoma was 72.7%. CONCLUSION: The presence of an obvious common channel was observed in 37.0%. A close relationship is suggested between the presence of a common channel and development of gallbladder carcinoma and acute pancreatitis.     

Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study

BACKGROUND: Anomalous pancreaticobiliary ductal junction, a rare congenital anomaly, is associated with various biliary and pancreatic diseases. The aim of this study was to determine the frequency of anomalous pancreaticobiliary ductal junction in Chinese patients with gallbladder cancer. METHODS: One thousand eight hundred seventy-six patients underwent ERCP between April 2000 and September 2001 with biliary and pancreatic duct opacification in 1082. Among the latter patients, those with proven gallbladder carcinoma were identified. Anomalous pancreaticobiliary ductal junction was defined as a common channel greater than 15 mm in length or a contractile segment totally distal to the union of the biliary and pancreatic ducts. When the common bile duct appeared to join the main pancreatic duct, the anomalous pancreaticobiliary ductal junction was denoted as B-P subtype; if the main pancreatic duct appeared to join the common bile duct, it was denoted P-B subtype. RESULTS: Fifty-four patients had gallbladder carcinoma, 7 of whom (3 men, 4 women) had anomalous pancreaticobiliary ductal junction (P-B subtype 6, B-P subtype 1). The mean (SD) length of the common channel was 21.0 mm (11.2 mm) with a range of 12 to 45 mm. One patient had early cystic dilation of bile duct. Three other patients had anomalous pancreaticobiliary ductal junction; 1 had an associated choledochal cyst and 2 a normal biliary tree. The overall frequency of anomalous pancreaticobiliary ductal junction was 0.9% (10/1082 cases). The frequency of anomalous pancreaticobiliary ductal junction was significantly higher in patients with gallbladder carcinoma (p < 0.001; OR, 50.7; 95% CI [12.7, 202.3]). CONCLUSIONS: Anomalous pancreaticobiliary ductal junction is strongly associated with gallbladder cancer among Chinese patients.     

Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

AIM: To clarify the strategy for early diagnosis of pancreaticobiliary maljunction (PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops.METHODS: The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography (ERCP). Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM. Of these, patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation. The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated. Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted.RESULTS: Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain (n = 16) or jaundice (n = 12). Radical surgery for gallbladder cancer was only possible in 11 patients (31%) and only 4 patients (11%) survived for 5 years. Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography (MRCP). The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer. All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred. Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls, and hyperplastic changes, hypertrophic muscular layer, subserosal fibrosis, and adenomyomatosis were detected in 7 (88%), 5 (63%), 7 (88%) and 5 (63%) patients, respectively. Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients.CONCLUSION: To detect PBM without biliary dilatation before onset of gallbladder cancer, we should perform MRCP for individuals showing increased gallbladder wall thickness on ultrasound.     

Pancreatitis associated with congenital abnormalities of the pancreaticobiliary system

BACKGROUND/AIMS: The relationship between pancreas divisum and pancreatitis remains controversial. The aim of this study was to examine the frequency and features of pancreatitis associated with congenital abnormalities of the pancreaticobiliary system, and the role that these malformations have in the occurrence of pancreatitis. METHODOLOGY: We retrospectively examined endoscopic retrograde cholangiopancreatograms of 6850 patients including 186 patients who were diagnosed clinically as having acute pancreatitis and 211 who were diagnosed as having chronic pancreatitis. RESULTS: A total of 175 patients were diagnosed as having congenital abnormalities of pancreaticobiliary system. Acute and chronic pancreatitis was associated respectively with 3.0% and 5.0% of patients with pancreaticobiliary maljunction (n=100), 17.1% and 28.6% of those with pancreas divisum (n=35), 6.6% and 20.0% of those with partial pancreas divisum (n=30), and 16.7% and 33.3% of those with choledochocele (n=6). These anomalies were present in 6.5% and 10.9% of patients with acute and chronic pancreatitis, respectively. Isolated chronic dorsal pancreatitis was detected in 8 patients with pancreas divisum. In chronic pancreatitis associated with pancreaticobiliary maljunction, pancreatic stones or protein plugs were situated only in the dilated common channel or main pancreatic duct of the head. CONCLUSIONS: Congenital abnormalities of the pancreaticobiliary system constitute one etiology of pancreatitis.     

Risk factor for extrahepatic bile duct cancer in patients with anomalous pancreaticobiliary ductal union

BACKGROUND/AIMS: Anomalous connection between the choledochus and pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cyst, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose was analysis of combined disease, especially biliary neoplasm and evaluated microscopic changes of extrahepatic bile ducts. METHODOLOGY: To study the clinical characteristics of anomalous pancreaticobiliary ductal union (APBDU), we reviewed 14 APBDU cases from June 1994 to June 1998. We studied the associated disease, surgical treatment, and the histological findings of the extrahepatic bile ducts. RESULTS: Gallbladder cancer was identified in 5 out of 14 patients with APBDU. The incidences of metaplasia of gallbladder and bile duct with APBDU were higher than that of control gallbladder epithelium. The proliferating cell nuclear antigen-labeling index of the gallbladder in patients with APBDU was significantly higher than that in the control group. CONCLUSIONS: The patients with APBDU showed high incidence of gallbladder carcinoma and metaplasia in epithelium of gallbladder and bile duct. As this metaplasia in the gallbladder and bile duct is thought of as a precancerous condition, it is important to remove the place that causes bile stasis and to stop backflow of pancreatic juice into the bile duct in managing patients with this anomaly. In other words, prophylactic cholecystectomy and reconstruction of the biliary tract are both necessary.     

Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal union

A total of 96 patients with gallbladder carcinoma in whom direct cholangiography clearly opacified the pancreaticobiliary ductal union and the common channel, and 65 patients with an anomalous union of these two duct systems at a distance greater than 15 mm from the papilla of Vater (normally less than 4.6 +/- 2.2 mm, mean +/- SD) were studied. It was found that this anomalous ductal union occurred in 16.7% of the patients with gallbladder carcinoma in comparison with an incidence of 2.8% among 641 consecutive patients with various hepatobiliary and pancreatic diseases studied by endoscopic retrograde cholangiopancreatography who did not have gallbladder carcinoma. It was also found that gallbladder carcinoma occurred in 24.6% of the 65 cases of anomalous ductal union in comparison with a 1.9% incidence of this cancer among 635 consecutive patients similarly studied and found to have normal ductal union (p less than 0.001). Thus, a close etiologic association was suggested between this anomaly in the terminal segment of the biliary tract and gallbladder carcinoma. Of the 65 patients with anomalous ductal union, 50 had the so-called congenital cystic dilatation of the common bile duct and 15 did not. Five of the 50 (10%) and 11 of the 15 (73.3%) had gallbladder carcinoma (p less than 0.01), and this carcinoma seems to be related to anomalous ductal union rather than to cystic dilatation of the common bile duct. As a tumorigenic factor in this anomaly, regurgitation of pancreatic juice has been stressed.