Endoscopic ultrasonography of bile duct malignancy and the preoperative assessment of local resectability.

Endoscopic ultrasonography (EUS) was performed before surgery in 12 patients with Klatskin tumour and in 8 patients with distal common bile duct carcinoma. The usual EUS findings consisted of an intraductular mass lesion together with adjacent lymph node involvement. The depth of malignant infiltration into the surrounding tissues could clearly be seen, which was of utmost importance in assessing local resectability. A clearly demarcated malignant growth with or without evidence of loco-regional lymph node involvement was considered compatible with local resectability. Involvement of distant lymph nodes along major blood vessels was thought to indicate palliative resection. Evidence of deep infiltration of the malignancy into the surrounding tissues (mesenteric artery, coeliac trunk, aorta) and/or organs (liver metastasis) was considered to indicate non-resectability. From this study EUS appears to be a sensitive modality for detecting, staging, and preoperative assessment of local resectability in bifurcation tumours and in distal bile duct malignancy. Technical improvements enabling guided cytological puncture and reducing the length of the rigid tip may further enhance its diagnostic value.