Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union

Figure 1 Endoscopic retrograde cholangiopancreatogram of choledochal cyst and microscopic change of extrahepatic bile duct. A: Todani type I and APBDU; B: Todani type IVa and APBDU; C: infiltration of small number of lymphocytes (inflammatory grade I); D: extensive infiltration of lymphocytes with surface erosion (inflammatory grade III); E: papillary epithelial growth, less than one-third (hyperplasia grade I); F: papillary epithelial growth, more than two-thirds (hyperplasia grade III).

Figure 2 Correlation between the age of symptomatic onset and bile duct amylase (n = 11) or gall bladder amylase (n = 10). A: There was highly significant correlation between age and level of amylase in bile duct; that is, the level of biliary amylase decreased with increasing age of onset (r = –0.982, P<0.01); B: in gall bladder (r = –0.636, P<0.05).

Figure 3 Correlation between grade of inflammation and size of cyst (n = 14). A: There was significant correlation between inflammation grade and size of choledochal cyst (r = 0.798, P<0.01); B: When the size was grouped by 4 cm, statistical significance was more remarkable (P<0.01).

Figure 4 Relationship between the age of symptomatic onset and grade of inflammation (n = 14). There was no correlation between the age and the grade of inflammation (r = 0.205, P>0.05).

Figure 5 Correlation between grade of hyperplasia and gall bladder amylase (n = 11). There was significant correlation between the grade of hyperplasia and gall bladder amylase; that is, the grade of hyperplasia increased with increasing the gall bladder amylase (r = 0.743, P<0.05).