4th Year Advanced Endoscopy Fellows Program | October 2021-Draganov_Clinical Case ASGE Advanced Fellow Course Oct 2021

Draganov_Clinical Case ASGE Advanced Fellow Course Oct 2021

Pdf Summary

This clinical case involves a 47-year-old female patient presenting with acute pancreatitis and abnormal lab values, including high amylase and lipase levels. Further tests reveal normal liver function and non-dilated bile ducts. The next step in the diagnosis is a right upper quadrant ultrasound followed by MRCP and then ERCP. The patient is found to have an anomalous pancreatobiliary junction (APBJ) associated with a Type I choledochal cyst.<br /><br />Choledochal cysts are further characterized using cholangioscope with NBI. In this case, the Type I choledochal cyst is found to have intestinal metaplasia. The management for this condition typically involves ERCP with sphincterotomy, particularly in the presence of APBJ without a choledochal cyst. APBJ is frequently associated with Type I choledochal cysts and can increase the risk of cholangiocarcinoma. Therefore, surgical resection is often recommended.<br /><br />Additionally, it is important for healthcare professionals to be aware of the association between APBJ and Type I choledochal cysts. When presented with an image of a Type I choledochal cyst, practitioners should also look for the presence of APBJ. This is crucial as APBJ can also be associated with gallbladder cancer, requiring cholecystectomy alongside other interventions. Overall, this case highlights the management considerations and associated risks for patients with APBJ and Type I choledochal cysts.

Keywords

acute pancreatitis

abnormal lab values

amylase

lipase

anomalous pancreatobiliary junction

APBJ

Type I choledochal cyst

choledochal cysts

cholangioscope

surgical resection