Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2019; 25(26): 3334-3343
Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3334
Choledochal cysts: Similarities and differences between Asian and Western countries
George N Baison, Morgan M Bonds, William S Helton, Richard A Kozarek
George N Baison, Morgan M Bonds, William S Helton, Richard A Kozarek, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Baison GN generated the figures and wrote the manuscript; Bonds MM, Helton WS, and Kozarek RA contributed to the writing of the manuscript; Baison GN and Kozarek RA designed the aim of the editorial and wrote the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Richard A Kozarek, AGAF, FACG, FACP, FASGE, MD, Doctor, Executive Director, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, C3-GAS. PO Box 900, Seattle, WA 98101, United States.
Telephone: +1-206-223-2319 Fax: +1-206-341-0061
Received: March 20, 2019
Peer-review started: March 21, 2019
First decision: April 4, 2019
Revised: May 5, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 14, 2019

Choledochal cysts (CCs) are rare bile duct dilatations, intra-and/or extrahepatic, and have higher prevalence in the Asian population compared to Western populations. Most of the current literature on CC disease originates from Asia where these entities are most prevalent. They are thought to arise from an anomalous pancreaticobiliary junction, which are congenital anomalies between pancreatic and bile ducts. Some similarities in presentation between Eastern and Western patients exist such as female predominance, however, contemporary studies suggest that Asian patients may be more symptomatic on presentation. Even though CC disease presents with an increased malignant risk reported to be more than 10% after the second decade of life in Asian patients, this risk may be overstated in Western populations. Despite this difference in cancer risk, management guidelines for all patients with CC are based predominantly on observations reported from Asia where it is recommended that all CCs should be excised out of concern for the presence or development of biliary tract cancer.

Keywords: Choledochal cyst, Cholangiocarcinoma, Asian populations, Western populations, Anomalous pancreaticobiliary junction

Core tip: Choledochal cysts (CCs) are rare, predominantly occurring in Asian populations. While current global guidelines for their management are based on studies on Asian populations, there may be relevant differences between Western and Asian populations. For example, the risk of malignancy in Western populations may be lower than that reported in Asian populations. Although studies on CC disease in Western populations have been conducted, further evidence is still needed to properly elucidate this disease in the West and design appropriate clinical guidelines. Continued efforts in this regard are paramount, especially with the evolving field of hepatobiliary surgery that has recently seen the adoption of minimally invasive techniques.