Opie’s Common Channel Hypothesis

We are grateful to Dr. Çiçek and his co-workers for commenting on our recent paper [1] and for reporting a similar case in which bile flow through the pancreatic duct had no adverse effect on the pancreas in a 54-year-old woman. As the authors indicate, this case lends further support to the hypothesis that pancreatic outflow obstruction, rather than Opie’s proposed reflux of bile into the pancreas through a common channel, is the cause of acute biliary pancreatitis.

Çiçek et al. further suggest that simultaneous dilation of the extrapancreatic common bile duct may be caused by a narrowing or stenosis at the atypical junction between the biliary tract and the pancreatic duct, rather than by reflux of pancreatic juice as suggested by O’Neill [2]. The absence of any cholestasis in Çiçek’s patient and the fact that pancreatic duct pressure exceeds bile duct pressure [3] still suggests, in our opinion, that the bile duct changes may be the consequence of exposure to pancreatic enzymes and not a primary event. However, on the basis of only a limited number of reported cases, it may not be possible to determine the ultimate cause of the enlarged bile ducts, and Çiçek et al. may be correct in their assessment.

On the other hand, we completely concur with our colleagues from Turkey that both cases strongly argue against Opie’s common channel theory as an explanation for the onset of acute biliary pancreatitis.

References

• 1 Pohle T, Konturek J W, Domschke W, Lerch M M. Spontaneous flow of bile through the human pancreatic duct in the absence of pancreatitis: nature’s human experiment.  Endoscopy. 2003;  35 1072-1075
• 2 O’Neill J A Jr. Choledochal cysts.  Curr Probl Surg. 1992;  29 361-410
• 3 Carr-Locke D L, Gregg J A. Endoscopic manometry of pancreatic and biliary sphincter zones in man: basal results in healthy volunteers.  Dig Dis Sci. 1981;  26 7-15