{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T18:20:03Z","timestamp":1774894803888,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,8,7]],"date-time":"2017-08-07T00:00:00Z","timestamp":1502064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have focused on the presence of reflux in selected cohorts with pancreaticobiliary maljunction (<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>), but little is known regarding the wider incidence of occult reflux and associated mucosal changes. We aimed to correlate gallbladder mucosal abnormalities with objective evidence of<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>and occult pancreaticobiliary reflux (<jats:styled-content style=\"fixed-case\">PBR<\/jats:styled-content>) in an Australian population undergoing cholecystectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing cholecystectomy between September 2010 and September 2012 were eligible for inclusion. Demographic and pre\u2010operative clinical data were collated and entered into a pre\u2010defined database. Operative cholangiograms were routinely performed and the presence of<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>noted. Gallbladder bile samples were analysed for bilirubin (&lt;20 \u00b5mol\/L), amylase (&lt;<jats:styled-content style=\"fixed-case\">100 U<\/jats:styled-content>\/L) and lipase (&lt;<jats:styled-content style=\"fixed-case\">70 U<\/jats:styled-content>\/L) levels. Evidence of<jats:styled-content style=\"fixed-case\">PBR<\/jats:styled-content>was correlated with gallbladder mucosal findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 305 cholecystectomies were performed for biliary colic (73%), choledocholithiasis (9%), cholecystitis (8.4%) and pancreatitis (6.4%). A total of 12.7% had cholangiographic evidence of<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>and 11.9% possessed gallbladder mucosal changes. Overall, 7.7% had increased biliary amylase, which was associated with significantly higher rates of gallbladder intestinal metaplasia (33% versus 8.6%;<jats:italic>P<\/jats:italic>= 0.012). Elevated biliary amylase was also higher in patients with prior pancreatitis (<jats:italic>P<\/jats:italic>= 0.02) or choledocholithiasis (<jats:italic>P<\/jats:italic>&lt; 0.01). The presence of<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>did not predict for the presence of<jats:styled-content style=\"fixed-case\">PBR<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">PBR<\/jats:styled-content>is associated with an increased frequency of gallbladder mucosal metaplasia, irrespective of the presence of<jats:styled-content style=\"fixed-case\">PBM<\/jats:styled-content>. Objectively identified reflux represents an additional indication for cholecystectomy but the long\u2010term consequences for extra\u2010hepatic biliary malignancy remain unknown and warrant further investigation. Methods of objectively identifying<jats:styled-content style=\"fixed-case\">PBR<\/jats:styled-content>pre\u2010operatively require further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.14136","type":"journal-article","created":{"date-parts":[[2017,8,7]],"date-time":"2017-08-07T11:24:43Z","timestamp":1502105083000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Gallbladder mucosal lesions associated with high biliary amylase irrespective of pancreaticobiliary maljunction"],"prefix":"10.1111","volume":"88","author":[{"given":"Jason","family":"Free","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Wang","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Williams","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1699-1665","authenticated-orcid":false,"given":"Justin S.","family":"Gundara","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph F.","family":"Staerkle","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Hugh","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaswinder S.","family":"Samra","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital The University of Sydney Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20756"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-002-0741-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)02586-6"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-008-2158-9"},{"key":"e_1_2_8_6_1","first-page":"159","article-title":"Daignostic criteria for pancreaticobiliary maljunction","volume":"21","author":"Kamisawa T","year":"2013","journal-title":"J. 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