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However, additional invasive tests such as ERCP or endoscopic ultrasonography (EUS) can reveal subtle structural pancreaticobiliary abnormalities and biliary microlithiasis. Sajith et al. [ 13] reported that after application of additional sophisticated/invasive imaging techniques (ERCP, MRCP, EUS), an etiological diagnosis was obtained in an additional 72 RAP patients for whom the etiology remained unknown after standard tests. [http://www.selleckchem.com/products/bmn-673.html check details] These causes included biliary microlithiasis (n=46), PD (n=16), PBM (n=1), choledochal cyst (n=1), and multiple etiology (n=7). Pancreaticobiliary malformation is one factor promoting recurrent episodes of pancreatitis by inducing a persistent or temporary obstruction to pancreatic juice flow into the duodenum or reflux of bile into the pancreatic duct, with a subsequent rise in intraductal pancreatic pressure. We examined pancreaticobiliary morphology in the 230 AP patients using ERCP. In this study, pancreaticobiliary malformation was diagnosed as the etiology of AP in 20 patients (9%), but the relapse rate of patients was high at 80%, with 16 RAP patients. All RAP involving pancreaticobiliary malformation was mild. It is unknown why these patients developed AP in advanced age regardless of congenital pancreaticobiliary malformation. PD is the most common pancreaticobiliary malformation, affecting 5%-8% of the Caucasian population [19?and?20]. This malformation occurs when the dorsal and ventral pancreatic ducts do [http://www.selleckchem.com/products/s-gsk1349572.html Selleckchem Dolutegravir] not communicate with each other. In PD, the dorsal pancreatic [https://en.wikipedia.org/wiki/CAPNS1 CAPNS1] duct becomes the main pancreatic duct and drains most of the pancreas through the minor duodenal papilla. However, as only a minority (