Progress on Diagnosis and Treatment of Congenital Biliary Dilation in Adult Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUYuan ,  LIUJin-gang

Department of General Surgery, The Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding?author：

LIUJin-gang, Email: liujg@sj-hospital.org

Keywords：

Adult; Congenital biliary dilation; Diagnosis; Treatment

DOI：

10.7507/1007-9424.20140316

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the recent development of diagnosis and treatment for congenital biliary dilation in adult patients. Method The literatures at home and abroad during recent years were reviewed, and the progress of diagnosis and treatment for congenital biliary dilation in adult patients were summarized. Results There were no specific clinical manifestations in adult patients of congenital biliary dilation. The diagnosis mainly depended on imaging examinations. Complete excision and Roux-en-Y hepatojejunostomy was the main the treatment method. Conclusions Early diagnosis and proper surgical approach are important for good therapeutic efficacy and lower postoperative complication rate.

Citation： LIUYuan, LIUJin-gang. Progress on Diagnosis and Treatment of Congenital Biliary Dilation in Adult Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1316-1320. doi: 10.7507/1007-9424.20140316 Copy

1.	Miyano T, Yamataka A, Li L. Congenital biliary dilatation[J]. Semin Pediatr Surg, 2000, 9(4):187-195.
2.	Clifton MS, Goldstein RB, Slavotinek A, et al. Prenatal diagnosis of familial typeⅠcholedochal cyst[J]. Pediatrics, 2006, 117(3):e596-e600.
3.	Tan SS, Tan NC, Ibrahim S, et al. Management of adult choledochal cyst[J]. Singapore Med J, 2007, 48(6):524-527.
4.	Edil BH, Cameron JL, Reddy S, et al. Choledochal cyst disease in children and adults:a 30-year single-institution experience[J]. J Am Coll Surg, 2008, 206(5):1000-1006.
5.	S?reide K, K?rner H, Havnen J, et al. Bile duct cysts in adults[J]. Br J Surg, 2004, 91(12):1538-1548.
6.	申銘, 張俊, 秦仁義.胰膽管合流異常與先天性膽管擴張癥[J].中國實用外科雜志, 2012, 32(3):244-246.
7.	Alonso-Lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94 cases[J]. Int Abstr Surg, 1959, 108(1):1-30.
8.	Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts:Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst[J]. Am J Surg, 1977, 134(2):263-269.
9.	Chaudhary A, Dhar P, Sachdev A, et al. Choledochal cysts-differences in children and adults[J]. Br J Surg, 1996, 83(2):186-188.
10.	de Vries JS, de Vries S, Aronson DC, et al. Choledochal cysts:age of presentation, symptoms, and late complications related to Todani's classification[J]. J Pediatr Surg, 2002, 37(11):1568-1573.
11.	Wiseman K, Buczkowski AK, Chung SW, et al. Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment[J]. Am J Surg, 2005, 189(5):527-531.
12.	Nicholl M, Pitt HA, Wolf P, et al. Choledochal cysts in western adults:complexities compared to children[J]. J Gastrointest Surg, 2004, 8(3):245-252.
13.	Visser BC, Suh I, Way LW, et al. Congenital choledochal cysts in adults[J]. Arch Surg, 2004, 139(8):855-862.
14.	Saluja SS, Nayeem M, Sharma BC, et al. Management of choledochal cysts and their complications[J]. Am Surg, 2012, 78(3):284-290.
15.	Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts[J]. Am J Surg, 1993, 165(1):238-242.
16.	陳燕凌, 韓圣華.先天性膽管擴張癥癌變及其治療[J].中國實用外科雜志, 2012, 32(3):196-198.
17.	Lee KF, Lai EC, Lai PB.Adult choledochal cyst[J]. Asian J Surg, 2005, 28(1):29-33.
18.	Huang SP, Wang HP, Chen JH, et al. Clinical application of EUS and peroral cholangioscopy in choledochocele with choledocholithiasis[J]. Gastrointest Endosc, 1999, 50(4):568-571.
19.	Singham J, Yoshida EM, Scudamore CH. Choledochal cysts:part 2 of 3:Diagnosis[J]. Can J Surg, 2009, 52(6):506-511.
20.	Metreweli C, So NM, Chu WC, et al. Magnetic resonance cholangiography in children[J]. Br J Radiol, 2004, 77(924):1059-1064.
21.	Sugiyama M, Haradome H, Takahara T, et al. Anomalous pancreaticobiliary junction shown on multidetector CT[J]. AJR Am J Roentgenol, 2003, 180(1):173-175.
22.	Sacher VY, Davis JS, Sleeman D, et al. Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts:case series and review[J]. World J Radiol, 2013, 5(8):304-312.
23.	Park DH, Kim MH, Lee SK, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts?[J]. Gastrointest Endosc, 2005, 62(3):360-366.
24.	Carrera C, Castiella A, Fernandez J, et al. Caroli's disease diagnosed by magneticresonance cholangiopancreatography[J]. Eur J Gastroenterol Hepatol, 2002, 14(5):577.
25.	Liu YB, Wang JW, Devkota KR, et al. Congenital choledochal cysts in adults:twenty-five-year experience[J]. Chin Med J (Engl), 2007, 120(16):1404-1407.
26.	Liu QY, Lai DM, Gao M, et al. MRI manifestations of adult choledochal cysts associated with biliary malignancy:a report of ten cases[J]. Abdom Imaging, 2013, 38(5):1061-1070.
27.	You Y, Gong JP. Diagnosis and management experience of adult choledochal cysts:reasons for reoperation[J]. Hepatogastroenterology, 2013, 60(123):470-474.
28.	Singham J, Yoshida EM, Scudamore CH. Choledochal cysts.Part 3 of 3:management[J]. Can J Surg, 2010, 53(1):51-56.
29.	彭淑牖, 王許安.先天性膽管擴張癥診治演變[J].中國實用外科雜志, 2012, 32(3):186-187.
30.	Takeshita N, Ota T, Yamamoto M.Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution[J]. Ann Surg, 2011, 254(6):1050-1053.
31.	Ohashi T, Wakai T, Kubota M, et al. Risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts[J]. J Gastroenterol Hepatol, 2013, 28(2):243-247.
32.	Lilly JR. Total excision of choledochal cyst[J]. Surg Gynecol Obstet, 1978, 146(2):254-256.
33.	彭淑牖, 王建偉.先天性膽總管囊腫術后遠期并發癥[J].中國實用外科雜志, 2002, 22(7):389-390.
34.	Shimotakahara A, Yamataka A, Yanai T, et al. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst:which is better?[J]. Pediatr Surg Int, 2005, 21(1):5-7.
35.	Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst[J]. J Hepatobiliary Pancreat Surg, 1999, 6(3):207-212.
36.	劉源, 周勇, 姚旭, 等.腹腔鏡手術治療成人先天性膽管擴張癥14例分析[J].中國實用外科雜志, 2012, 32(3):218-219.
37.	Liu Y, Liu B, Zhou Y, et al. Treatment of long-term complications after primary surgery for congenital choledochal cysts[J]. Am Surg, 2013, 79(11):1221-1224.
38.	Urushihara N, Fukumoto K, Fukuzawa H, et al. Long-term outcomes after excision of choledochal cysts in a single institution:operative procedures and late complications[J]. J Pediatr Surg, 2012, 47(12):2169-2174.
39.	Felder SI, Menon VG, Nissen NN, et al. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction[J]. JAMA Surg, 2013, 148(3):253-258.
40.	Farello GA, Cerofolini A, Rebonato M, et al. Congenital choledochal cyst:video-guided laparoscopic treatment[J]. Surg Laparosc Endosc, 1995, 5(5):354-358.
41.	劉金鋼.全腹腔鏡下成人先天性膽管擴張癥治療策略[J].中國實用外科雜志, 2012, 32(3):198-200.
42.	Kang CM, Chi HS, Kim JY, et al. A case of robot-assisted excision of choledochal cyst, hepaticojejunostomy, and extracorporeal Roux-en-y anastomosis using the da Vinci surgical system[J]. Surg Laparosc Endosc Percutan Tech, 2007, 17(6):538-541.
43.	Jang JY, Yoon YS, Kang MJ, et al. Laparoscopic excision of a choledochal cyst in 82 consecutive patients[J]. Surg Endosc, 2013, 27(5):1648-1652.
44.	Gander JW, Cowles RA, Gross ER, et al. Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(10):877-881.
45.	Hwang DW, Lee JH, Lee SY, et al. Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults[J]. Surg Endosc, 2012, 26(11):3324-3329.
46.	Jab?ońska B. Biliary cysts:etiology, diagnosis and management[J]. World J Gastroenterol, 2012, 18(35):4801-4810.
47.	吳志勇, 陳煒.Ⅲ型先天性膽管擴張癥診斷與治療[J].中國實用外科雜志, 2012, 32(3):193-196.
48.	Dong JH, Yang SZ, Xia HT, et al. Aggressive hepatectomy for the curative treatment of bilobar involvement of typeⅣ-A bile duct cyst[J]. Ann Surg, 2013, 258(1):122-128.
49.	Zheng X, Gu W, Xia H, et al. Surgical treatment of typeⅣ-A choledochal cyst in a single institution:children vs. adults[J]. J Pediatr Surg, 2013, 48(10):2061-2066.
50.	Harring TR, Nguyen NT, Liu H, et al. Caroli disease patients have excellent survival after liver transplant[J]. J Surg Res, 2012, 177(2):365-372.
51.	Mabrut JY, Kianmanesh R, Nuzzo G, et al. Surgical management of congenital intrahepatic bile duct dilatation, Caroli's disease and syndrome:long-term results of French Association of Surgery Multicenter Study[J]. Ann Surg, 2013, 258(5):713-721.
52.	Kimura W. Congenital dilatation of the common bile duct and pancreaticobiliary maljunction:clinical implications[J]. Langenbecks Arch Surg, 2009, 394(2):209-213.
53.	劉穎斌, 馬孝明, 王建偉, 等.先天性膽總管囊腫癌變20例報告[J].中國實用外科雜志, 2007, 27(9):723-724.
54.	Mabrut JY, Bozio G, Hubert C, et al. Management of congenital bile duct cysts[J]. Dig Surg, 2010, 27(1):12-18.
55.	Cho MJ, Hwang S, Lee YJ, et al. Surgical experience of 204 cases of adult choledochal cyst disease over 14 years[J]. World J Surg, 2011, 35(5):1094-1102.
56.	Takeshita N, Ota T, Yamamoto M. Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution[J]. Ann Surg, 2011, 254(6):1050-1053.
57.	Kim JW, Moon SH, Park do H, et al. Course of choledochal cysts according to the type of treatment[J]. Scand J Gastroenterol, 2010, 45(6):739-745.
58.	Gong L, Qu Q, Xiang X, et al. Clinical analysis of 221 cases of adult choledochal cysts[J]. Am Surg, 2012, 78(4):414-418.
59.	Lee SE, Jang JY, Lee YJ, et al. Choledochal cyst and associated malignant tumors in adults:a multicenter survey in South Korea[J]. Arch Surg, 2011, 146(10):1178-1184.

1. Miyano T, Yamataka A, Li L. Congenital biliary dilatation[J]. Semin Pediatr Surg, 2000, 9(4):187-195.
2. Clifton MS, Goldstein RB, Slavotinek A, et al. Prenatal diagnosis of familial typeⅠcholedochal cyst[J]. Pediatrics, 2006, 117(3):e596-e600.
3. Tan SS, Tan NC, Ibrahim S, et al. Management of adult choledochal cyst[J]. Singapore Med J, 2007, 48(6):524-527.
4. Edil BH, Cameron JL, Reddy S, et al. Choledochal cyst disease in children and adults:a 30-year single-institution experience[J]. J Am Coll Surg, 2008, 206(5):1000-1006.
5. S?reide K, K?rner H, Havnen J, et al. Bile duct cysts in adults[J]. Br J Surg, 2004, 91(12):1538-1548.
6. 申銘, 張俊, 秦仁義.胰膽管合流異常與先天性膽管擴張癥[J].中國實用外科雜志, 2012, 32(3):244-246.
7. Alonso-Lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94 cases[J]. Int Abstr Surg, 1959, 108(1):1-30.
8. Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts:Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst[J]. Am J Surg, 1977, 134(2):263-269.
9. Chaudhary A, Dhar P, Sachdev A, et al. Choledochal cysts-differences in children and adults[J]. Br J Surg, 1996, 83(2):186-188.
10. de Vries JS, de Vries S, Aronson DC, et al. Choledochal cysts:age of presentation, symptoms, and late complications related to Todani's classification[J]. J Pediatr Surg, 2002, 37(11):1568-1573.
11. Wiseman K, Buczkowski AK, Chung SW, et al. Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment[J]. Am J Surg, 2005, 189(5):527-531.
12. Nicholl M, Pitt HA, Wolf P, et al. Choledochal cysts in western adults:complexities compared to children[J]. J Gastrointest Surg, 2004, 8(3):245-252.
13. Visser BC, Suh I, Way LW, et al. Congenital choledochal cysts in adults[J]. Arch Surg, 2004, 139(8):855-862.
14. Saluja SS, Nayeem M, Sharma BC, et al. Management of choledochal cysts and their complications[J]. Am Surg, 2012, 78(3):284-290.
15. Chijiiwa K, Koga A. Surgical management and long-term follow-up of patients with choledochal cysts[J]. Am J Surg, 1993, 165(1):238-242.
16. 陳燕凌, 韓圣華.先天性膽管擴張癥癌變及其治療[J].中國實用外科雜志, 2012, 32(3):196-198.
17. Lee KF, Lai EC, Lai PB.Adult choledochal cyst[J]. Asian J Surg, 2005, 28(1):29-33.
18. Huang SP, Wang HP, Chen JH, et al. Clinical application of EUS and peroral cholangioscopy in choledochocele with choledocholithiasis[J]. Gastrointest Endosc, 1999, 50(4):568-571.
19. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts:part 2 of 3:Diagnosis[J]. Can J Surg, 2009, 52(6):506-511.
20. Metreweli C, So NM, Chu WC, et al. Magnetic resonance cholangiography in children[J]. Br J Radiol, 2004, 77(924):1059-1064.
21. Sugiyama M, Haradome H, Takahara T, et al. Anomalous pancreaticobiliary junction shown on multidetector CT[J]. AJR Am J Roentgenol, 2003, 180(1):173-175.
22. Sacher VY, Davis JS, Sleeman D, et al. Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts:case series and review[J]. World J Radiol, 2013, 5(8):304-312.
23. Park DH, Kim MH, Lee SK, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts?[J]. Gastrointest Endosc, 2005, 62(3):360-366.
24. Carrera C, Castiella A, Fernandez J, et al. Caroli's disease diagnosed by magneticresonance cholangiopancreatography[J]. Eur J Gastroenterol Hepatol, 2002, 14(5):577.
25. Liu YB, Wang JW, Devkota KR, et al. Congenital choledochal cysts in adults:twenty-five-year experience[J]. Chin Med J (Engl), 2007, 120(16):1404-1407.
26. Liu QY, Lai DM, Gao M, et al. MRI manifestations of adult choledochal cysts associated with biliary malignancy:a report of ten cases[J]. Abdom Imaging, 2013, 38(5):1061-1070.
27. You Y, Gong JP. Diagnosis and management experience of adult choledochal cysts:reasons for reoperation[J]. Hepatogastroenterology, 2013, 60(123):470-474.
28. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts.Part 3 of 3:management[J]. Can J Surg, 2010, 53(1):51-56.
29. 彭淑牖, 王許安.先天性膽管擴張癥診治演變[J].中國實用外科雜志, 2012, 32(3):186-187.
30. Takeshita N, Ota T, Yamamoto M.Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution[J]. Ann Surg, 2011, 254(6):1050-1053.
31. Ohashi T, Wakai T, Kubota M, et al. Risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts[J]. J Gastroenterol Hepatol, 2013, 28(2):243-247.
32. Lilly JR. Total excision of choledochal cyst[J]. Surg Gynecol Obstet, 1978, 146(2):254-256.
33. 彭淑牖, 王建偉.先天性膽總管囊腫術后遠期并發癥[J].中國實用外科雜志, 2002, 22(7):389-390.
34. Shimotakahara A, Yamataka A, Yanai T, et al. Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst:which is better?[J]. Pediatr Surg Int, 2005, 21(1):5-7.
35. Watanabe Y, Toki A, Todani T. Bile duct cancer developed after cyst excision for choledochal cyst[J]. J Hepatobiliary Pancreat Surg, 1999, 6(3):207-212.
36. 劉源, 周勇, 姚旭, 等.腹腔鏡手術治療成人先天性膽管擴張癥14例分析[J].中國實用外科雜志, 2012, 32(3):218-219.
37. Liu Y, Liu B, Zhou Y, et al. Treatment of long-term complications after primary surgery for congenital choledochal cysts[J]. Am Surg, 2013, 79(11):1221-1224.
38. Urushihara N, Fukumoto K, Fukuzawa H, et al. Long-term outcomes after excision of choledochal cysts in a single institution:operative procedures and late complications[J]. J Pediatr Surg, 2012, 47(12):2169-2174.
39. Felder SI, Menon VG, Nissen NN, et al. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction[J]. JAMA Surg, 2013, 148(3):253-258.
40. Farello GA, Cerofolini A, Rebonato M, et al. Congenital choledochal cyst:video-guided laparoscopic treatment[J]. Surg Laparosc Endosc, 1995, 5(5):354-358.
41. 劉金鋼.全腹腔鏡下成人先天性膽管擴張癥治療策略[J].中國實用外科雜志, 2012, 32(3):198-200.
42. Kang CM, Chi HS, Kim JY, et al. A case of robot-assisted excision of choledochal cyst, hepaticojejunostomy, and extracorporeal Roux-en-y anastomosis using the da Vinci surgical system[J]. Surg Laparosc Endosc Percutan Tech, 2007, 17(6):538-541.
43. Jang JY, Yoon YS, Kang MJ, et al. Laparoscopic excision of a choledochal cyst in 82 consecutive patients[J]. Surg Endosc, 2013, 27(5):1648-1652.
44. Gander JW, Cowles RA, Gross ER, et al. Laparoscopic excision of choledochal cysts with total intracorporeal reconstruction[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(10):877-881.
45. Hwang DW, Lee JH, Lee SY, et al. Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults[J]. Surg Endosc, 2012, 26(11):3324-3329.
46. Jab?ońska B. Biliary cysts:etiology, diagnosis and management[J]. World J Gastroenterol, 2012, 18(35):4801-4810.
47. 吳志勇, 陳煒.Ⅲ型先天性膽管擴張癥診斷與治療[J].中國實用外科雜志, 2012, 32(3):193-196.
48. Dong JH, Yang SZ, Xia HT, et al. Aggressive hepatectomy for the curative treatment of bilobar involvement of typeⅣ-A bile duct cyst[J]. Ann Surg, 2013, 258(1):122-128.
49. Zheng X, Gu W, Xia H, et al. Surgical treatment of typeⅣ-A choledochal cyst in a single institution:children vs. adults[J]. J Pediatr Surg, 2013, 48(10):2061-2066.
50. Harring TR, Nguyen NT, Liu H, et al. Caroli disease patients have excellent survival after liver transplant[J]. J Surg Res, 2012, 177(2):365-372.
51. Mabrut JY, Kianmanesh R, Nuzzo G, et al. Surgical management of congenital intrahepatic bile duct dilatation, Caroli's disease and syndrome:long-term results of French Association of Surgery Multicenter Study[J]. Ann Surg, 2013, 258(5):713-721.
52. Kimura W. Congenital dilatation of the common bile duct and pancreaticobiliary maljunction:clinical implications[J]. Langenbecks Arch Surg, 2009, 394(2):209-213.
53. 劉穎斌, 馬孝明, 王建偉, 等.先天性膽總管囊腫癌變20例報告[J].中國實用外科雜志, 2007, 27(9):723-724.
54. Mabrut JY, Bozio G, Hubert C, et al. Management of congenital bile duct cysts[J]. Dig Surg, 2010, 27(1):12-18.
55. Cho MJ, Hwang S, Lee YJ, et al. Surgical experience of 204 cases of adult choledochal cyst disease over 14 years[J]. World J Surg, 2011, 35(5):1094-1102.
56. Takeshita N, Ota T, Yamamoto M. Forty-year experience with flow-diversion surgery for patients with congenital choledochal cysts with pancreaticobiliary maljunction at a single institution[J]. Ann Surg, 2011, 254(6):1050-1053.
57. Kim JW, Moon SH, Park do H, et al. Course of choledochal cysts according to the type of treatment[J]. Scand J Gastroenterol, 2010, 45(6):739-745.
58. Gong L, Qu Q, Xiang X, et al. Clinical analysis of 221 cases of adult choledochal cysts[J]. Am Surg, 2012, 78(4):414-418.
59. Lee SE, Jang JY, Lee YJ, et al. Choledochal cyst and associated malignant tumors in adults:a multicenter survey in South Korea[J]. Arch Surg, 2011, 146(10):1178-1184.

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Progress on Diagnosis and Treatment of Congenital Biliary Dilation in Adult Patients

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