CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(07): E801-E805
DOI: 10.1055/a-0605-3331
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Heads or tails: confusion about “proximal” and “distal” terminology for pancreaticobiliary anatomy

Harshit S. Khara
 1  Center for Advanced Therapeutic Endoscopy, Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Truptesh H. Kothari
 2  Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, United States
,
Amitpal S. Johal
 1  Center for Advanced Therapeutic Endoscopy, Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Shivangi T. Kothari
 2  Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, United States
,
Nina Ahuja
 1  Center for Advanced Therapeutic Endoscopy, Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Ashok Bhanushali
 3  Department of Vascular and Interventional Radiology, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Anil Kotru
 4  Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Andrea Berger
 5  Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States
,
Vivek Kaul
 2  Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, United States
,
Seth A. Gross
 6  Department of Gastroenterology, NYU Langone Medical Center, New York, New York, United States
,
Christopher J. DiMaio
 7  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
William B. Hale
 8  Department of Gastroenterology, Norwalk Hospital Gastroenterology Consultants, Norwalk, Connecticut, United States
,
Rami Abbass
 9  Digestive Health Institute, University Hospitals, Cleveland, Ohio, United States
,
Marvin Ryou
10  Division of Gastroenterology, Brigham & Women's Hospital, Boston, Massachusetts United States
,
Amrita Sethi
11  Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, United States
,
Brian G. Turner
12  Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Cornell University, New York, New York, United States
,
Paul Fockens
13  Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
,
David L. Diehl
 1  Center for Advanced Therapeutic Endoscopy, Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

submitted 05 January 2018

accepted after revision 05 March 2018

Publication Date:
04 July 2018 (online)

Abstract

Background and study aims The anatomical meaning of the terms “proximal” and “distal” in relation to the pancreaticobiliary anatomy can be confusing. We aimed to investigate practice patterns of use of the terms “proximal” and “distal” for pancreaticobiliary anatomy amongst various medical specialties.

Materials and methods An online survey link to a normal pancreaticobiliary diagram was emailed to a multispecialty physician pool. Respondents were asked to label various parts of the common bile duct (CBD) and pancreatic duct (PD) using the terms “proximal,” “distal,” “not sure,” or “other.” Variability in use of these terms between specialties was assessed.

Results We received 370 completed surveys from 182 gastroenterologists (49.2 %), 97 surgeons (26.2 %), 68 radiologists (18.4 %), and 23 other physicians (6.2 %). There was overall consensus in describing the upper/sub-hepatic CBD as “proximal CBD” (73.8 %, P = 0.1499) and the lower/pre-ampullary portion as “distal CBD” (84.6 %, P = 0.1821).

However, there was marked variability when describing the PD. The PD in the head of the pancreas was labeled as “proximal PD” by 42.4 % and “distal PD” also by 42.4 % (P < 0.0001); and in the tail as “proximal PD” by 41.4 % and “distal PD” by 43.2 % (P < 0.0001). Only 13.8 % of respondents used descriptive terminology (“PD in the head” or “PD in the tail”) for the PD. Radiologists most often used descriptive terminology for both the CBD and PD. Surgeons most consistently called “proximal PD” in the head, and “distal PD” in the tail of the pancreas.

Conclusions Although use of the terms “proximal” and “distal” is still very common to describe pancreaticobiliary anatomy, there is a discordance about its meaning, particularly for the PD. Use of descriptive terminology may be a more accurate alternative to prior ambiguous terminologies such as “proximal” or “distal” and can serve to improve communication and decrease the possibility of medical errors.