Pancreaticobiliary reflux as a high-risk factor for biliary malignancy: Clinical features and diagnostic advancements

Figure 4 A 75-year-old male with common bile duct carcinoma without pancreaticobiliary maljunction. A: Magnetic resonance cholangiopancreatography image shows the irregular wall throughout the entire common bile duct, with bile duct carcinoma revealed by biopsy. During endoscopic retrograde cholangiopancreatography, amylase level was measured in the bile. The amylase level in the collected bile was 1415 IU/L, higher than the upper limit of serum amylase of 130 IU/L; B and C: Labeled pancreatic juice in the main pancreatic duct refluxing into the common bile duct. Reprinted from Sugita et al[43] (by permission of Wiley Periodicals, Inc).