Choledochal cysts: Similarities and differences between Asian and Western countries

Table 1 Classification of choledochal cysts according to the Todani classification

Todani classification
Type I	Solitary extrahepatic cyst
Type II	Extrahepatic supraduodenal diverticulum
Type III	Intraduodenal cyst
Type IV	Both extrahepatic and intrahepatic cysts
Type V	Multiple intrahepatic cysts

Table 2 Summary data for the five largest Western studies compared to the five largest Eastern studies, specifically investigating the presentation and management of choledochal cyst disease in the last 20 years

		Western					Eastern					Aggregate
		Moslim et al[6]	Edil et al[2]	Soares et al[11]	Singham et al[12]	Baison et al (unpublished data)	Shi et al[8]	She et al[9]	Woon et al[10]	He et al[25]	Lee et al[24]	Aggrega-te East	Aggrega-te West
Single-center or multi-center		Single	Single	Multiple	Single	Single	Multiple	Single	Single	Single	Multiple	3-Single2-Multi	4-Single1-Multi
Total number		67	92	394	70	103	108	83	32	214	808	32-808	67-394
Adults		78%	79%	66%	73%	100%	84%	0%	100%	-	100%	0-100%	66%-100%
Study period		1984 - 2014	1976-2006	1972-2014	1985-2002	1998-2018	1980-2000	1978-2008	1991-2005	1968-2013	1990-2007	1968-2013	1972-2018
APBJ		-	-	8% (cancer patients only)	-	57.3%	93.4%	-	-	81.2%	71.4%	71.4%-93.4%	8%-57.3%
Female:Male ratio		4:01	9:01	3.2:1	4.2:1	4.7:1	3.7:1	2.6:1	3.5:1	3.7:1	3.8:1	2.6:1-3.8:1	3.2:1-9:1
Age (yr)		46 (55.6-34.3)	-	45 (SD 15.2)	-	44.53 (18-74)	27.8 (3-68)	4 (0-16)	41 (18-74)	36.2 (1-78)	42 (18-82)	4-42	44-46
Symp-tomatic		72%	-	84.5%	-	83%	-	-	91%	98%	88%	88%-91%	72%-85%
Presen-tation	Abdom-inal pain only	51%	91%	61%	88%	44%	57%	47%	91%	78%	75%	47%-91%	44%-91%
	Pancrea-titis (recurr-ent)	-	31%	19%	-	9%	-	22%	-	13%	-	13%-22%	9%-31%
	Choleli-thiasis	-	58%	-	-	8%	-	-	-	22%	-	22 --	8%-58%
	Jaundice	15%	34%	19%	39%	6%	71%	42%	41%	25%	21%	21%-71%	6%-39%
	Cholecy-stitis	-	-	-	-	6%	-	-	-	28%	-	28% --	6 --
	Cholan-gitis (recurr-ent)	-	-	-	-	3%	56%	-	-	-	-	56% --	3 --
	Choled-ocholith-iasis	-	-	-	-	3%	-	-	-	29%	28%	28%-29%	3 --
	Weight loss, Bloating	-	8%	-	-	2%	-	-	-	-	-	- - -	2%-8%
	Other	-	2%	-	-	2%	-	-	9%	-	-	9% --	2%-2%
	Acute pancrea-titis	13%	-	-	-	1%	-	-	-	-	-	- - -	1%-13%
	Fever/ chills	-	26%	-	39%	-	57%	-	34%	19%	-	19%-57%	26%-39%
	Nausea/vomiting	-	47%	-	63%	-	-	31%	38%	-	-	31%-38%	47%-63%
	Abdom-inal mass	-	-	-	-	-	-	22%	25%	4%	-	4%-25%	- - -
	Classic triad	-	-	-	-	-	-	2%	13%	-	-	2%-13%	- - -
CC type	I	73%	67%	70%	33%	71%	69%	68%	84%	65%	68%	65%-84%	67%-73%
	II	1.5%	7%	5%	6%	3%	-	5%	6%	1.4%	0.9%	0.9%-6%	3%-7%
	III	-	4%	2%	2%	5%	0.9%	3%	-	0.5%	0.5%	0.5%-3%	2%-5%
	IV	13.4%	19%	18%	55%	18%	22%	19%	6%	25%	30%	6%-30%	18%-19%
	V	12%	2%	4.9%	4%	4%	5.60%	5%	3%	8%	0.7%	0.7%-8%	2%-12%
Prior cholec-ystec-tomy		-	38%	32%	-	28%	-	-	3%	31%	7%	3%-31%	28%-38%
Surgery		100%	100%	98.9%	100%	70%	100%	90%	84%	92%	100%	84%-100%	70%-100%
Biliary Malig-nancy	On presen-tation	7.5%	5.4%	3%	7.8%	7%	17%	0%	3%	5%	10%	0-17%	3-8%
	On follow-up/re-currence	1.5%	3.2%	3.30%	-	0%	10%	0%	0%	2.3%	3%	0-10%	0-3%
Overall mortal-ity		7.5%	7.6%	4.50%	0%	2%	9%	0%	0%	6%	4%	0-9%	0-8%

SD: Standard deviation; CC: Choledochal cyst; APBJ: Anomalous pancreaticobiliary junction.