title: Carcinoma arising in choledochocele.
abstract: OBJECTIVE
  Choledochocele has a potential for carcinogenesis, but no report has described malignant changes of the choledochocele in relation to pancreaticobiliary reflux because its anatomic form does not fit the criteria of pancreaticobiliary malunion (PBM). The aims of this study were to analyze the amylase level in bile in patients with choledochocele and to clarify whether the presence of a choledochocele predisposed to carcinoma.
  
  
  METHODS
  Records of 2826 patients who had undergone endoscopic retrograde cholangiopancreatography between 1995 and 1999 were reviewed for the presence of choledochocele and/or periampullary carcinoma. As an evidence of pancreaticobiliary reflux, amylase activity was examined in common duct bile obtained at surgery or by endoscopy. The prevalence of periampullary carcinoma was compared between patients with and without choledochocele.
  
  
  RESULTS
  A total of 11 patients were diagnosed as having a choledochocele. The amylase level in bile was higher in patients with choledochocele (120,922 +/- 62,269 IU/l; n = 4) than in previously examined patients with functioning gallbladders (15 +/- 24 IU/l; n = 10, P = 0.005). The prevalence of periampullary carcinoma in patients with choledochocele (27%, 3/11) was significantly higher than that in those without choledochocele (0.9%, 26/2815; P<0.0002).
  
  
  CONCLUSIONS
  The bile analysis of the present study presents one possible explanation for the predisposition to carcinoma in choledochocele as bile containing amylase may stagnate in the choledochocele and then carcinoma may develop in the inner epithelium of the choledochocele by the same mechanism as that leading to carcinogenesis in patients with PBM.
authors.affiliation: Dept. of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: K
authors.initials: K
authors.lastname: Inoue
authors.forename: J
authors.initials: J
authors.lastname: Ohuchida
authors.forename: T
authors.initials: T
authors.lastname: Nabae
authors.forename: S
authors.initials: S
authors.lastname: Takahata
authors.forename: H
authors.initials: H
authors.lastname: Niiyama
authors.forename: K
authors.initials: K
authors.lastname: Yokohata
authors.forename: Y
authors.initials: Y
authors.lastname: Ogawa
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D001646:Bile / Q000201:enzymology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015529:Choledochal Cyst / Q000150:complications* / Q000175:diagnosis / Q000201:enzymology; D003135:Common Bile Duct / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000209:etiology*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000681:Amylases