BACKGROUND/AIMS: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer. METHODS: One hundred and sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. RESULTS: When the location of the tumor was divided into intrahepatic (IHD), hilar and common bile duct, the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (p<0.05). After a bile duct cancer had been classified as a nodular (n=31), papillary (n=27) or infiltrative type (n=58) upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96.3%) were significantly higher than from infiltrative types (58.6%; p<0.01). However, cholangioscopic classification of bile duct cancer was the only independent factor affecting biopsy yield by multiple logistic regression analysis (p=0.001). The sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that for cholangioscopic biopsies (p<0.01) or for tumor vessels alone (p<0.01). CONCLUSIONS: The cholangioscopic classification of bile duct tumors might provide important clues to predict biopsy yield.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Biopsy* ; Classification ; Common Bile Duct ; Humans ; Logistic Models

PURPOSE: To compare survival outcomes between bile duct segmental resection (BDR) and pancreatoduodenectomy (PD) for the treatment of middle and distal bile duct cancer. METHODS: From 1997 to 2013, a total of 96 patients who underwent curative intent surgery for middle and distal bile duct cancer were identified. The patients were divided into 2 groups based on the type of operation; 20 patients were included in the BDR group and 76 patients were in the PD group. We retrospectively reviewed the clinical outcomes. RESULTS: The number of lymph nodes (LNs) was significantly greater in patients within the PD group compared to the BDR group. The total number of LNs was 6.5 ± 8.2 vs. 11.2 ± 8.2 (P = 0.017) and the number of metastatic LNs was 0.4 ± 0.9 vs. 1.0 ± 1.5 (P = 0.021), respectively. After a median follow-up period of 24 months (range, 4–169 months), the recurrence-free survival of the PD group was superior to that of the BDR group (P = 0.035). In the patients with LN metastases, the patients undergoing PD had significantly better survival than the BDR group (P < 0.001). CONCLUSION: Surgeons should be cautious in deciding to perform BDR for middle and distal common bile duct cancer. PD is recommended if LN metastases are suspected.
Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Cholangiocarcinoma ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Pancreaticoduodenectomy* ; Recurrence ; Retrospective Studies ; Surgeons

Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the extrahepatic bile duct. To the best of our knowledge, it is a completely benign lesion, but making a clear distinction from malignancy on preoperative evaluation is very difficult. Its clinical importance mainly lies in the possibility that they may be confused with carcinoma, leading to unnecessarily extensive surgical resections. We report here on a case of distal common bile duct adenomyoma that presented with right upper quadrant abdominal pain, and the preoperative examinations could not reveal whether the tumor was benign or malignant. It was finally diagnosed by histological examination after performing pylorus preserving pancreaticoduodenectomy.
Abdominal Pain ; Adenomyoma* ; Bile Ducts, Extrahepatic ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Gastrointestinal Tract ; Pancreaticoduodenectomy ; Pylorus

PURPOSE: There are several reports that intraoperative transfusion may be a prognostic factor in periampullary cancer, but it is not conclusive. The purpose of this study is to clarify the prognostic significance of a transfusion following a pancreatoduodenectomy for periampullary cancers. METHODS: We analyzed 357 periampullary cancers from 1985 to 1997 (ampullary cancer: 130 cases; distal bile duct cancer: 141 cases; and pancreatic head cancer: 86 cases). Analytic variables for possible prognostic factors were various clinicopathologic factors combined with the presence of the perioperative transfusion. RESULTS: Of the overall 357 patients, 215 (60%) have received an intraoperative transfusion. The 5-year survival rate of the 130 ampullary cancer patients was 59%, and 76 cases (58%) underwent an intra operative transfusion. The 5-year survival rate of patients without intraoperative transfusion was 79% whereas that of patients with a transfusion was 47% (p=0.029). Following multivariate analysis, an intraoperative transfusion was an independent prognostic factor in ampullary cancer (relative risk: 2.174). In common bile duct cancer, the overall 5-year survival rate was 33%, and the 5-year survival rates of patients with (N=87) or without (N=54) a transfusion were 25% and 38% respectively, which showed a marginal statistical significance (p=0.0717). In pancreatic head cancer, the overall 5-year survival rate was 16% and there was no survival difference between transfused (N=52) and untransfused (N=34) patients. CONCLUSION: In the present study, intraoperative transfusion was an independent significant prognostic factor in ampullary cancer. Careful dissection to minimize intraoperative bleeding is mandatory in pancreatoduodenectomy for ampullary cancer.
Bile Duct Neoplasms ; Common Bile Duct ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Survival Rate

BACKGROUND/AIMS: Brush cytology during ERCP can provide a pathologic diagnosis in malignant biliary obstruction. K-ras and p53 mutations are commonly found in biliary and pancreatic cancers. We evaluated the diagnostic yield of brush cytology and the changes obtained by adding p53 and K-ras staining. METHODS: One hundred and forty patients with biliary obstruction who underwent ERCP with brush cytology during a 7-year period were included. The sensitivity and specificity of brush cytology only and with the addition of p53 and K-ras staining were obtained. RESULTS: Malignant biliary obstruction was confirmed in 119 patients. The sensitivity and specificity of brush cytology were 78.2% and 90.5%, respectively. The sensitivity of cytology was 77.3% at the ampulla-distal common bile duct (CBD), 92.6% at the mid common hepatic duct (CHD), and 94.7% at the proximal CBD-CHD (p<0.05); these values did not differ with the degree or the length of the obstruction. In the 97 patients who received additional p53 and K-ras staining, the sensitivity of cytology plus p53 was 88.2%, cytology plus K-ras was 84.0%, and cytology plus p53 and K-ras was 88.2%. The sensitivity of cytology plus p53 was higher than that of brush cytology only (95% confidence interval: 83.69-92.78 vs 72.65-83.65) but not that of cytology plus K-ras. CONCLUSIONS: Brush cytology for malignant biliary obstruction has a high diagnostic accuracy. Adding p53 staining can further improve the diagnostic yield, whereas K-ras staining does not.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Hepatic Duct, Common ; Humans ; Pancreatic Neoplasms ; Sensitivity and Specificity

Multiple synchronous malignancies are defined as the occurrence of two or more primary malignant tumors whose pathogenetic processes are believed to be independent or unrelated. Multiple synchronous biliary carcinomas are not frequently reported. The diagnosis is often made as a result of incidental intraoperative discovery of a gallbladder mass during surgical treatment of extrahepatic cholangiocarcinoma. We experienced a case of synchronous double primary cancer of the gallbladder and distal common bile duct confirmed by pathologic evaluation, and report the case with a review of the clinical literature.
Biliary Tract* ; Cholangiocarcinoma ; Common Bile Duct ; Diagnosis ; Gallbladder ; Gallbladder Neoplasms

BACKGROUNDS/AIMS: Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extrahepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgical procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection. METHODS: We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a > or =2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years. RESULTS: The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively. CONCLUSIONS: We suggest that extended EHBD resection can be performed as a beneficial option to achieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome.
Aged ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Hepatic Duct, Common ; Humans ; Pancreatic Juice ; Pancreaticoduodenectomy ; Survival Rate

Primary carcinoma of the bile duct is uncommon but not rare and its prognosis is poor even though long-termsurvival had been reported. The authors presented 62 cases of bile duct cancer, which were confirmed at YUMC fromJan. 1971 to Dec. 1981. The results were as follows; 1. The most prevalent age group was 6th decade and a male-tofemale ratio was 1.9:1. 2. Jaundice was the most common clinical manifestations(84%), and followed by right
Bile Duct Neoplasms ; Bile Ducts ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Diagnosis ; Dilatation ; Hepatomegaly ; Humans ; Jaundice ; Prognosis ; Ultrasonography

The authors analysed retrospectively 56 cases of bile duct cancer, which were confirmed by histologically in47 cases and highly suuspected by clinically and radiologically in 9 cases. The resutls were as follows: 1. Themost prevalent age groups were 5th decade and a male to female ratio is 2.7:1. 2. The location of bile ductcarcinomas were common bile duct in 36%, common hepatic duct in 25%, junction in 13%, porta haptis in 11% anddiffuse involvement in 5%. 3. The accuracy of predicting obstruction is by ultrasonography was 76%. 4. Correctdiagnosis as bile duct carcinoma was made in 29 cases(43%). 5. The echogenicity of bile duct carcinoma compare toliver parenchyme was hyperechoic in 10 cases(34.5%), isoechoic in 14 cases(48.3%) and hypoechoic in 5cases(17.2%). 6. Posterior acoustic shadowing was seen in 5 cases. 7. The shape of obstruction site was abruptcut-off in 12 cases(41%), funnel shape in 7 cases(24%) and indistinct in 10 cases(35%).
Acoustics ; Bile Duct Neoplasms ; Bile Ducts ; Bile ; Biliary Tract ; Common Bile Duct ; Female ; Hepatic Duct, Common ; Humans ; Male ; Retrospective Studies ; Shadowing (Histology) ; Ultrasonography

Of the various anomalies of the biliary system, a double common bile duct (DCBD) is extremely rare. According to a report by Boyden, the first case of DCBD was reported by Vesalius in 1543, with few additional case reports since 1986. Cancer and Anomalous pancreatobiliary ductal union (APBDU) are the two of the most serious concomitant conditions. A 69-year-old female was admitted to our hospital with the complaint of jaundice. An abdominal computed tomography and percutaneous transhepatic cholangiography revealed a mass lesion at the distal common bile duct. The patient underwent Whipple's operation, and the operative finding showed a septum in the common bile duct, with a DCBD opening as a single duct into the ampulla of Vater. A histological examination showed an adenocarcinoma in the ampulla of Vater. Herein, a case of the ampulla of Vater cancer in a patient with a double common bile duct is reported, with a review of the literature.
Adenocarcinoma ; Aged ; Ampulla of Vater* ; Biliary Tract ; Cholangiography ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Female ; Humans ; Jaundice