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Occult pancreaticobiliary reflux is observed in a considerable number of ERCP candidates. Those who show an extremely high biliary amylase level, at least, may be at high risk for biliary malignancies.

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The risk factors for the cooccurrence of head and neck cancer and that of gastric cancer in patients with ESCC differ. This information will likely be useful for managing patients who have been treated with ER for ESCC and who possess carcinogenic potential throughout the upper gastrointestinal tract.

Aim:We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS-BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal extent of bile duct cancer. Methods: Between November 1999 and January 2005, we performed IDUS-BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS-BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS-BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated. Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS-BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS-BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS-BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS-BD and TPB. Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS-BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS-BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.