Abstract

COVA, Jorge  and  LOUIS, César. Anatomical variations of biliary tract: diagnosis by ERCP and their relationship with biliary diseases. Gen [online]. 2016, vol.70, n.1, pp.016-022. ISSN 2477-975X.

Introduction: anatomic variants of the biliary tract are frequent, so his knowledge is of utmost importance for performing surgical procedures of the bile ducts as laparo-scopic cholecystectomy to prevent incidental injury of the biliar tree; in this study these variants were determined by retrograde cholangiopancreatography (ERCP) and its relationship with diseases of the biliary tract. Patient and Method: All patients who attended in the Gastroenterology Service of the University Hospital of Caracas with indicating ERCP, were evaluated, and 232 subjects were included, divided into two groups, one composed of subjects with presence of anatomic variants of the biliary tract, another for patients without anatomic variants of the biliary tract, then both groups coexisting illnesses related. Results: 168 cases with cystic duct variants, corresponding to 72.4%, and 56 cases with anatomical variations of intrahepatic bile ducts, corresponding to 24.1% were found. The most common anatomic variant cystic duct corresponded to the posterior insertion (n = 32; 19.1%), finding combinations with other variants of the cystic duct (posterior/spiral in 5 cases, posterior/high in 1 case, 1 case posterior/low and posterior/low/spiral in 1 case). The second variant more common was low insertion (n = 18; 10.7%). Most common variant of intrahepatic bile duct was the type B (n= 25; 44.6%), followed by type C1 (n= 18; 32.1%). Choledocholithiasis was the most frequent diagnosis in both patients with anatomical variants, as in no anatomical variants, corresponding respectively to 33.3% vs 34.8%; p= 0.40. Of patients with choledocholithiasis, the more common anatomical variant of cystic duct was low insertion (17.5%). Conclusions: The anatomic variants of the biliary tract are common. The more common anatomical variant of cystic duct was low insertion, while anatomical variant of the intrahepatic bile ducts was the type B. The most common pathology, both in patients with anatomical variant and in patients without anatomic variant, was choledocholithiasis. However, no association between the anatomic variants of the biliary tract and biliary diseases was found.

Keywords : anatomic variants; biliary tract; endoscopic retrograde cholangiopan-creatography; ERCP.