Occult pancreatobiliary reflux with hyperplastic changes and cholesterolosis of the gallbladder

Abstract

Occult pancreatobiliary reflux refers to a condition in which pancreatic juice flows back into the biliary tract with a normal pancreaticobiliary junction.

A 45-year-old woman was found to have gallbladder wall thickening on abdominal ultrasonography screening. Endoscopic ultrasonography showed thickening of the inner hypoechoic layer and scattered areas of punctate hyperechoic foci inside the layer. Endoscopic retrograde cholangiopancreatography showed no abnormalities in the pancreaticobiliary junction, and the biliary amylase level in the bile in the bile duct was 1962 IU/l. Therefore, we diagnosed occult pancreatobiliary reflux. The patient was considered to be at high risk for gallbladder cancer and underwent prophylactic cholecystectomy. Pathological examination revealed hyperplastic changes and cholesterolosis of the gallbladder, which corresponded to the findings of endoscopic ultrasonography. Our experience suggests that if endoscopic ultrasonography shows gallbladder wall thickening and multiple punctate hyperechoic foci on the luminal side of the gallbladder wall, endoscopic retrograde cholangiopancreatography should be performed suspecting pancreatobiliary reflux. Direct cholangiopancreatography and intraductal amylase measurement are useful.