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Review
. 2025 Apr 25;13(5):1039.
doi: 10.3390/biomedicines13051039.

A Systematic Review and Meta-Analysis on the Prevalence of Variants in the Pancreaticobiliary Duct Junction and Its Association with Cancer

Juan José Valenzuela-Fuenzalida  1 , Antonia Beas-Gambi  1 , Josefa Matta-Leiva  1 , Daniela Martínez-Hernández  1 , Daniel Milos  1 , Mathias Orellana-Donoso  2 , Alejandra Suazo Santibáñez  3 , Alejandro Bruna-Mejias  1 , Andres Sebastian Riveros  4 , Alvaro Becerra-Farfan  5 , Juan Sanchis-Gimeno  6 , Héctor Gutierrez-Espinoza  7 , Carlos Bastidas-Caldes  8
Affiliations
Review

A Systematic Review and Meta-Analysis on the Prevalence of Variants in the Pancreaticobiliary Duct Junction and Its Association with Cancer

Juan José Valenzuela-Fuenzalida et al. Biomedicines. .

Abstract

Background/Objectives: The objective of this study was to describe the anatomical variants of the pancreaticobiliary junction and how its position or structural change could be associated with hepatic, duodenal, and pancreatic clinical complications. Methods: We searched MEDLINE, Scopus, Web of Science (WOS), Google Scholar, CINAHL, and EMBASE databases from their inception up to September 2024. Results: Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with an assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. A total of 59 studies with a total of 22,752 participants were included in this review. The overall prevalence of the anomalous pancreaticobiliary junction (APBJ) variant was 12% (95% CI = 6% to 18%). The prevalence of cancer associated with variants of APBJ was 29% (95% CI = 23% to 34%). Conclusions: In the present anatomical systematic review and meta-analysis, we found that a longer common channel correlated with a higher prevalence of bile duct or gallbladder malignancy, due to the backward flow of bile which occurs as a result of the position and distance of the bile ducts, as well as pancreatic failing. Hence, APBJs are of great interest for gastroduodenal surgeons.

Keywords: cancer; pancreaticobiliary junction (PBJ); pancreaticobiliary junction cancer; pancreaticobiliary maljunction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Variants of the pancreaticobiliary junction—a representation of the Komi classification of anomalies of the biliopancreatic junction (APBJ). Type I: the angle of the joint C-P is perpendicular; Ia without dilatation of the common duct; and Ib with dilation of the common duct. Type II: obtuse-angle P-C junction; and IIa without dilatation of the common duct; IIb with dilatation of the common duct. Type III: complex APBJ; IIIa is the complete pancreas divisum with biliary dilatation; IIIb represents an absence of the main pancreatic duct; IIIc1 presents a small communication duct between the main and accessory pancreatic duct; IIIc2 shows that the communication between the main and accessory duct is of the same caliber as the ducts; and IIIc3 is the same as type IIIc2, but with dilated ducts.
Figure 2
Figure 2
Flow diagram of study selection according to PRISMA.
Figure 3
Figure 3
Geographic distribution of reviewed studies and total number of participants included in studies.
Figure 4
Figure 4
Box plot of studies included in Komi classification [20,53].
Figure 5
Figure 5
Box plot of studies included in Kimura classification [32,35,75].
Figure 6
Figure 6
A forest plot of the studies included in the APBJ prevalence analysis [2,3,12,13,15,29,31,34,39,41,42,53,75].
Figure 7
Figure 7
A forest plot of the correlation between APBJ and cancer prevalence [3,14,29,30,71,72,73,74].
Figure 8
Figure 8
Risk of bias evaluation for case studies [9,56,57,58,59,60,61,62,63,64,65,66,67,68,69].
Figure 9
Figure 9
Assessing risk of bias in observational studies [3,6,8,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,38,39,41,45,57].
See this image and copyright information in PMC

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