Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba, 260-8670, Japan,
J Hepatobiliary Pancreat Sci. 2010 May;17(3):230-5. doi: 10.1007/s00534-009-0153-z. Epub 2009 Aug 11.
BACKGROUND/PURPOSE: Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is considered an uncommon tumor. The purpose of this study was to evaluate the diagnostic utility of endoscopic cholangiography (ERC) with subsequent peroral cholangioscopy (POCS) and/or intraductal ultrasonography (IDUS) for this tumor.
From December 1991 to November 2006, a retrospective analysis was made of eight patients with IPMN-B. Their clinical features and the endoscopic diagnostic strategy for POCS and IDUS were reviewed.
In all the patients, ERC failed to show papillary tumors, due to coexisting mucin or biliary sludge. POCS was carried out after ERC and it showed the presence and locations of papillary tumors in all patients, except for one with a tumor in the peripheral intrahepatic bile duct (B3). IDUS was performed in seven of the eight patients; in five of these patients, intraductal protruding tumors were clearly visualized, whereas flat tumors were not identified in the remaining two patients. In one of the eight patients, endoscopic nasobiliary drainage did not remove the huge amount of mucin. Hence, this patient required subsequent percutaneous biliary drainage. Six of the eight patients underwent surgical treatment; five patients underwent a hepatic resection with or without extrahepatic bile duct resection and one underwent a pancreaticoduodenectomy. Five of the six operated patients are still alive; one patient died of gastric cancer 90 months after the operation (mean follow-up period, 45.3 months). The two remaining patients, who were considered inoperable due to major medical comorbidities, died of liver failure and cholangitis 3 and 6 months, respectively, after stent placement.
ERC failed to delineate intraductal papillary tumors, due to coexisting mucin. The presence and location of papillary tumors were correctly diagnosed by both POCS and IDUS, but POCS may be better than IDUS to diagnose the extent of the tumor.
背景/目的：胆管内乳头状黏液性肿瘤（IPMN-B）被认为是一种罕见的肿瘤。本研究的目的是评估内镜下胆管造影（ERC）联合经口胆道镜（POCS）和/或胆管内超声（IDUS）对该肿瘤的诊断价值。
回顾性分析 1991 年 12 月至 2006 年 11 月期间收治的 8 例 IPMN-B 患者的临床特征及 POCS 和 IDUS 的内镜诊断策略。
所有患者的 ERC 均因同时存在黏液或胆泥而未能显示出乳头状肿瘤。在 ERC 后进行了 POCS，除了 1 例位于肝外胆管周围（B3）的肿瘤外，其余 7 例患者均显示出乳头状肿瘤的存在和位置。在 8 例患者中有 7 例进行了 IDUS 检查，5 例患者可见明显的腔内隆起性肿瘤，而另外 2 例患者未发现平坦型肿瘤。在 8 例患者中有 1 例因大量黏液而无法进行内镜鼻胆管引流，故行经皮胆管引流。8 例患者中有 6 例接受了手术治疗；5 例患者行肝切除术联合或不联合肝外胆管切除术，1 例患者行胰十二指肠切除术。6 例手术患者中有 5 例仍存活；1 例患者术后 90 个月死于胃癌（平均随访时间为 45.3 个月）。另外 2 例因严重合并症而被认为无法手术的患者分别在支架置入后 3 个月和 6 个月死于肝功能衰竭和胆管炎。
由于同时存在黏液，ERC 未能描绘出腔内乳头状肿瘤。POCS 和 IDUS 均能正确诊断出乳头状肿瘤的存在和位置，但 POCS 可能比 IDUS 更能诊断肿瘤的范围。
